The Feeling of What Happens-Antonio Damasio

Machine Translated by Google
Index
COVER
SYNOPSIS
TITLE
DEDICATION
QUOTE
ACKNOWLEDGMENTS
FIRST PART. INTRODUCTION CHAPTER
ONE GETTING OUT ON THE STAGE
SECOND PART. FEEL AND KNOW CHAPTER TWO
EMOTION AND SENSATION CHAPTER THREE
CENTRAL AWARENESS CHAPTER FOUR THE
HALF-HINTED HINT PART THREE. A BIOLOGY FOR KNOWING
CHAPTER FIVE THE ORGANISM AND THE OBJECT CHAPTER SIX
THE CONSTRUCTION OF CENTRAL CONSCIOUSNESS CHAPTER
SEVEN EXTENDED CONSCIOUSNESS CHAPTER EIGHT THE
NEUROLOGY OF CONSCIOUSNESS
FOURTH PART. FORCED TO KNOW CHAPTER NINE

FEELING SENSATIONS CHAPTER TEN USING
CONSCIOUSNESS CHAPTER ELEVEN IN THE
SPOTLIGHT
APPENDIX NOTES ON THE MIND AND THE BRAIN
GRADES
CREDITS
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SYNOPSIS
How can our mind come to know? How can we have sensation and
awareness of being? How does the transition from ignorance and
unconsciousness to knowledge and identity of being occur? These are
the questions raised and answered in this book by Antonio Damasio, one
of the world's leading experts in neurology.
Anthony Damasius
The feeling of what is happening

Body and emotion in
the construction of consciousness
Translation by Francisco Páez of Cadena Tortosa

for hanna
Or the waterfall, or music heard so deep inside

you can't even hear it, though you are the music while
the music lasts. They are only hints and guesses, hints followed by
guesses; and the rest is prayer, observance, discipline, thought and
action.
The hint half hinted at, the gift half understood, is [Incarnation.
TS ELIOT
"Dry Salvages," from Four Quartets
The question of who I was consumed me.
I convinced myself that I would not find the image of the person I was:
seconds passed. What rose to the surface in me sank down again and
out of sight. All in all, I felt that the moment of my first investiture was
the moment that I began to represent myself... the moment that I began
to live... gradually... second by second... relentlessly... Oh mind, what
are you doing!...
Do you want to be covered or do you want to be seen?
And your clothing... how it becomes you!... starred with

the eyes of others, sobbing...
JORIE GRAHAM
"Notes on the reality of being", from Materialism
THANKS
My first thanks go to Seamus Heaney for his unwitting contribution

to the title of this book. The end of his poem "Song" speaks of "when
the bird sings much like the music of what passes." The feeling of
what happens was my spontaneous, and perhaps inevitable,
adaptation of his verse to the specific theme of this book.
During the preparation of the manuscript I was fortunate to spend

many hours discussing my ideas with fellow patients and experts. I
single out Hanna Damasio, whose ideas and suggestions are a
continual inspiration; to Josef Parvizi, whose brainstem expertise
helped shape my views on this brain region, making the task of
tackling its complexities much easier than it would have been without
his enthusiasm; to Ralph Adolphs, who has an open mind but never
takes an explanation for granted; to Charles Rockland, who hardly
accepts any explanation but is an extremely constructive and
generous colleague; to Patricia Churchland, whose insistence on
transparency is a welcome challenge; and to my eternal critic, Mrs.
Lundy, which was much less severe than I expected.

I have also had during this period the advice of many colleagues who
have read the text and provided suggestions. Among them, Victoria
Fromkin, Jack Fromkin, Paul Churchland, Fernando Gil, Jerome
Kagan, Fred Plum, Pierre Rainville, Kathleen Rockland, Daniel Tranel,
Stefan Heck, Antoine Bechara, Samuel Dunnam, Ursula Bellugi and
Edward Klima. I have benefited greatly from your comments and I
thank you for your wisdom and kindness.
I am equally grateful to the friendship with which, once the

manuscript was completed, it was pored over and commented on
generously by various colleagues. They are Gerald Edelman, Giulio
Tononi, Jean-Pierre Changeux, Francis Crick, Thomas Metzinger,
and David Hubel who, like a dream reader, leaves no idea unexamined
and no comma unturned. Responsibility for remaining errors and
oddities is mine, of course.
I am grateful to my colleagues in the Department of Neurology

at the University of Iowa, especially the members of the Cognitive
Neuroscience area, for what they have taught me over the years and
for the spirit in which they have helped create a unique environment
for brain and mind research; and to the National Institute of
Neurological Diseases and the Mathers Foundation, whose grants
have made such an environment a reality. I am equally grateful to the
neurology patients who have been studied in our Cognitive
Neuroscience unit for the opportunity they have given us to understand
their problems.
My assistant Neal Purdum coordinated the preparation of the

manuscript, and both Betty Redeker, who has translated my lyrics for
sixteen years, and Donna Wenell typed the manuscript with
professionalism and dedication. Denise Krutzfeldt and Jon Spardling
helped me with the bibliographic sources in their usual capacity.
I am grateful to Rachel Myers for her clever proofreading and to

David Hough for the patience and precision with which he made sure
everything came to fruition. Finally, I gratefully acknowledge the
support and guidance of two friends, Jane Isay and Michael Carlisle,
without whose advice and enthusiasm the completion of this project
would not have been possible.
FIRST PART
INTRODUCTION
CHAPTER ONE
GO ON STAGE
GO ON STAGE
I've always been fascinated by that particular moment when,

while we're sitting in our seats waiting, the stage door opens and an
actor comes out; or, to put ourselves in the opposite perspective, that
moment in which the actor who waits in the semi-darkness sees how
that same door opens and the lights, the stage and the public become
clear to him.
I realized a few years ago that the poignant quality of that
moment, whichever point of view we take, came from its incarnation
in a kind of birth, passage of a threshold that separated the protected
but limited refuge of the possibilities and the risks of a world beyond.
However, as I prepare for the launch of this book and as I reflect on

what I have written, I realize that going onstage is also a powerful
metaphor for consciousness, for the birth of the conscious mind, for
the simple but momentous arrival of the be to the world of the mental.
Precisely the subject of this book is the appearance of consciousness.
I write about the sensation of being and about the transition from
ignorance and unconsciousness to knowledge and identity of being.
My specific goal is to take into account the biological circumstances
that allow such a transition.
It is not easy to investigate any aspect of the human mind, and

for those who wish to understand the biological underpinnings of the
mind, it is usually the problem of consciousness that is the largest,
despite the fact that the very definition of the problem may vary
greatly from one to another. one researcher to another. If elucidating
the mind is the last frontier in the life sciences, consciousness often
seems like the ultimate mystery in elucidating the mind. And there
are those who consider it unsolvable.
Still, it's hard to think of a more tempting challenge to think about
and investigate. The business of the mind in general, and that of
consciousness in particular, allows humans to exercise, ad nauseam,
the desire for understanding and that appetite for wonder at nature
itself that Aristotle recognized as so distinctively human. What could
be more complex to know than knowing how we know? What could
be more dizzying than the realization that it is precisely having
consciousness that makes our questions about consciousness
possible, even inevitable?
Although for me consciousness is not the pinnacle of biological

evolution, I do understand it as a turning point in the long history of
life. Even when we stick to the simple, standard dictionary definition
(as an organism's awareness of itself and its environment) it is easy
to see how consciousness may have paved the way in human
evolution for a new order of creations that was not would have been
possible without it: consciousness, religion, political and social
organizations, arts, sciences and technology. It is even more striking
that consciousness is the fundamental biological function that allows
us to distinguish pain from joy, suffering from pleasure, that allows us
to feel embarrassment or pride, that allows us to grieve for lost love
or life. . Whether experienced or observed, pathos is a byproduct of
consciousness, as is desire. Without
consciousness none of these states would be known to us. Let's not

blame Eva for knowledge: let's blame conscience, and thank you,
fortunately.
I am writing this in the center of Stockholm as I look out the
window and watch a frail little man walking towards the ferry that is
about to set sail. He has little time left, but he takes small steps; her
ankles twist from arthritis; he has white hair and wears a shabby coat.
It rains insistently and the wind makes it lean slightly like a tree in an
open field. Finally, he reaches the ship. He climbs with difficulty the
high step that allows him to reach the gangway and begins the descent
towards the deck, afraid of taking too much of a run on the descent,
making sudden movements of his head to the right and left, controlling
his surroundings and seeking to reassure himself, while all his body
seems to say: is this it? am I where I need to be? what should I do
next? And then the two men on deck help him firmly to take his last
step, leading him into the cabin with warm gestures, and he seems to
be safe where he should be. I stop worrying. The ship sails.
Let us now let our minds wander and consider that, without
awareness, the old man's discomfort, perhaps even his humiliation,
would simply have been unknown to him. Without conscience, the two
men on deck would not have responded with such empathy. Without
awareness, I would not have cared and never thought that maybe one
day I would be him, walking with that same painful hesitation and
feeling that same discomfort. Consciousness amplifies the impact of
these feelings on the minds of the characters in your scene.
Indeed, awareness is the key, for better or worse, to the life under
review, our ticket to knowing everything about hunger, thirst, sex,
tears, laughter, kicks, punches, flow of images that we call thought,
feelings, words, stories, beliefs, music and poetry, happiness and
ecstasy. At its simplest and
elemental, consciousness allows us to recognize the irresistible urge to stay

alive and to develop a concern for being. At its most complex and intricate,
consciousness helps us develop a concern for other beings and improve the
art of living.
AWOL*
Thirty-two years ago, I was sitting across from a man in a strange, circular,
all-gray exam room. As we talked quietly the evening sun beat down on us
through a skylight. Suddenly, the man stopped in the middle of a sentence and
his face became immobile; the paralyzed mouth, still open, the eyes fixed
vacantly on a point on the wall behind me. For a few seconds he was
motionless. I called out his name but got no response. Then he moved slightly,
smacked his lips, looked at the table between him and me, seemed to see a
cup of coffee and a small metal vase; he had to see them, because he picked
up the cup and took a sip. He touched the vase. I asked him what was going
on and he still didn't answer, his face expressionless. He didn't look at me.
Then he stood up and seemed nervous; I didn't know what could happen. I
called him again and he didn't answer. When would that end? He turned around
and walked slowly towards the door. I got up and called him back. He stopped,
looked at me and recovered part of his facial expression... he seemed puzzled.
I called him again and he said "What?"

For a brief time, which seemed to last centuries, the man suffered from
impaired consciousness. Neurologically speaking, he had an absence seizure
followed by an absence automatism, two of the many manifestations of
epilepsy, a disease caused by brain dysfunction. It was not the first time that I
had seen an impaired conscience, but it was the most fascinating. From the
subject's perspective I knew what it was
dissolve into an unwanted unknowing to later return to consciousness:

I had lost consciousness as a child, in an accident, and as a teenager
I had once undergone general anesthesia. He had also seen patients
in a coma and had observed, from the outside, what an unconscious
state looked like. However, in all these cases, the same as when one
falls asleep or wakes up, the loss of consciousness was radical, a
kind of total meltdown. But what I saw that afternoon in that circular
classroom was much more amazing. This man had not collapsed
into a coma, nor had he fallen asleep. He was there but he wasn't, of
course awake, partly receptive, with a certain behavior, present in
body but not personally, absent without finishing leaving.
I did not forget the episode and one fine day I felt that I could
give it an interpretation. I did not think then, though I do now, that I
had seen the very fine transition between a fully conscious mind and
a mind deprived of the sense of being. During that period of impaired
consciousness, the man's wakefulness, his basic ability to relate to
objects, and his ability to move in space had been preserved. He
probably retained the essence of his thought processes, at least as
far as the objects in his environment were concerned, but his sense
of being and knowing was gone. My formulation of consciousness
probably began that day without my realizing it, and the idea that an
indispensable part of the conscious mind was a certain sense of
being only gained strength when I saw other comparable cases.
I maintained my interest in the subject of consciousness over

the years, both attracted by the scientific challenge posed by
consciousness and repelled by the human consequences of its
decline, but continued to keep my distance. The drama of situations
in which brain damage causes a coma or a permanent vegetative
state, of diseases in which consciousness is truncated in the most
radical way, is something that
I would have preferred not to witness if I had been able to choose.

Few things are sadder than observing the sudden and forced
disappearance of the mind in someone who is still alive and there
are few things more painful than explaining it to a family. How do you
look a person in the face and make it clear to them that the calm
state of their lifelong partner may seem like a dream but it is not, that
this way of resting is not benign or restorative, that this being that
once felt can never feel again? But even if my life as a neurologist
hadn't warned me about consciousness, my life as a neuroscientist
would have made sure I didn't embark on the problem. Studying
consciousness wasn't a pre-academic job; and once achieved it was
an occupation to be regarded with suspicion. Only in recent years
has consciousness become a somewhat more normal subject of
scientific inquiry.1 However, the reason I ended up pursuing
consciousness had little to do with the sociology of consciousness
studies. Of course, I had not planned to investigate consciousness
until a break forced me to do so. The hiatus had to do with my work
on emotions, which means I can blame the passions of the soul.2 So
here it is. He could understand reasonably well how different emotions
were induced in the brain and acted out in the theater of the body.
He could also imagine the induction of emotions, and the subsequent

bodily changes were marked in different brain structures suitable for
mapping such changes, thus constituting the substratum of emotions
and feelings. But not even if my life had gone into it, I could
understand how this substratum of sensations could make itself
known to the organism that experienced the emotion. He could not
devise a satisfactory explanation for what we conscious creatures
call sensation becoming known to the sentient organism. By what
additional mechanism does it know
each of us who is given a sensation within the limits of his own

organism? What other things happen in the body and, above all, what
other things happen in the brain when we know that we feel an
emotion or a pain or, to ask, when we know what it is? I had run into
the obstacle of conscience. Specifically, I had run into the obstacle of
being, because something like a feeling of being was needed so that
the signals that constitute the feeling of an emotion could be known
to the organism that experiences it.
I realized that overcoming the self hurdle (which in my view

meant understanding its neural underpinnings) might help us
understand the vastly different biological impact of three closely
related yet distinct phenomena: emotion, feeling that emotion , and
knowing that we feel that emotion. And not least, overcoming the
obstacle of being could also help us elucidate the neural basis of
consciousness in general.
THE PROBLEM OF CONSCIOUSNESS
Therefore, from the perspective of neurobiology, what is the

problem of consciousness? As much as I see the issue of being as a
fundamental issue in the elucidation of consciousness, it is important
to clarify that the problem of consciousness is not restricted to the
issue of being. In the simplest possible summary, I see the problem
of consciousness as a combination of two closely related problems.
The first is the problem of understanding how the brain of the human
organism engenders the mental patterns that we call, for lack of a
better term, images of an object. By object I understand entities as
diverse as a person, a place, a melody, a toothache, a state of
happiness; by image I understand a guideline
mental in any of the sensory modalities, that is, a sound image, a tactile image, the
image of a state of well-being. These images convey aspects of the physical
characteristics of the object and can also suggest the reaction of like or dislike that we
can have for an object, the plans that we can formulate with respect to it or the network
of relationships of that object among many others. Honestly, this problem of
consciousness is the problem of how we get "a movie into our brains," provided we
realize that in this crude metaphor the movie has as many sensory cues as there are
sensory inputs to our nervous system: sight , sound, taste, smell, touch, internal
senses and so on. (See the glossary in the appendix for a comment on the use of
terms such as image, representation , and map.)
From the perspective of neurobiology, solving this first problem consists of

discovering how the brain manufactures neural patterns in its circuits of nerve cells
and how it is put together to convert those neural patterns into the explicit mental
patterns that constitute the highest level of biological phenomenon, which I like to call
images. Solving this problem necessarily includes addressing the philosophical issue
of qualia. Qualia are the simple sensory qualities found in the blue of the sky or in the
tone of sound produced by a cello, and therefore the essential components of the
images of the film metaphor are made of qualia. I think they will end up explaining
themselves neurobiologically, although at the moment the neurobiological explanation
is incomplete and there is a gap that is not explained.3
these qualities
Let us now come to the second problem of consciousness. This is the problem
of how, while mental patterns for objects are generated, the brain also generates a
sense of being in the act of knowing. To help me clarify what I mean by being and
knowing, I ask you to check your presence in yourself at this time.
You are looking at this page, reading the text and reconstructing
the meaning of my words as you go.
But dealing with text and meaning hardly describes everything that
happens to you inside your brain. Along with the representation of
the printed words and the display of knowledge that is required to
understand what I have written, your mind must also display
something else, something that is sufficient to indicate, moment after
moment, that it is you and not someone else who read and understand
the text. The sensory images that you perceive externally, and the
related images that you evoke, occupy most of your mental range,
but not all of it.
In addition to those images there is that other presence that means
"you", as observer of the things that provoke images, owner of those
imagined things, potential actor of the imagined things. There is a
presence of you in a concrete relationship with a certain object. If
there is no such presence in you, how could your thoughts belong to
you? Who would insure it? That presence is quiet and subtle and is
sometimes little more than a "half-guessed hint," a "half-understood
gift," to use TS Eliot's words. Later I will propose that the simplest
form of such a presence is also an image, precisely the kind of image
that constitutes a feeling. With such a perspective, the presence of
"you" is the sensation of what happens when your being is modified
in the act of apprehending something. The presence never disappears,
from the moment we wake up to the moment we begin to sleep. That
presence must be there or there is no "you" to count on.
The solution of this second problem requires the understanding

of how, while I write, I have a feeling of myself and how, when you
read, you have a feeling of you; how we feel that this private
knowledge that you and I have in our respective minds, at this very
moment, is configured from a concrete perspective, that of the
individual in which it is formed, and not from a canonical perspective
that could serve for the whole
world. The solution also requires an understanding of how images of

an object and the complex matrix of related relationships, reactions,
and plans are experienced as the unambiguous mental property of
an automatic owner who, for all intents and purposes, is an observer,
a perceiver, a viewer. connoisseur, a thinker and a potential actor.
This second problem is all the more intriguing since we can be sure
that the solution that has traditionally been proposed (a homuncular
creature that is in charge of knowing) is obviously wrong. There is no
homunculus, metaphysical or cerebral, sitting in the Cartesian theater
as an audience for one and waiting for objects to come on stage.4 In
other words, solving the second problem of consciousness consists
in discovering the biological underpinnings for this curious ability that
we humans have to construct not only mental patterns of an object
(images of people, places, melodies and their relationships or, in
short, of temporally and spatially integrated mental images of
everything we know) but also of mental patterns that transmit,
automatically and naturally, the sensation of being in the act of
knowing. Consciousness, as we generally conceive of it, from its
simplest degree to its most complex degree, is the unified mental
pattern that groups object and being together.
Thus, at a minimum, the neurobiology of consciousness faces

two problems: the problem of how the mind's movie is generated,
and the problem of how the brain also generates the sense that there
is an owner and observer of such a movie.
Both are so highly related that the second problem nests within the
first. In effect, the second is to generate the appearance of an owner
and observer for the film within the film; and the physiological
mechanisms underlying the second problem have their influence on
the mechanisms of the first. However, despite the proximity of the
two problems, to separate them is to chop up the problem of
consciousness, and to chop it up is to make general research on
consciousness manageable.5
This book is nothing more than an attempt to deal with the

obstacle of consciousness by coming face to face with the problem of
being but without neglecting or minimizing the "other" problem of
consciousness. This attempt was given to me by the pause on the
emotions that I have indicated previously but it has gone far beyond
the focus on this specific point. The book deals with my idea of what
consciousness is in mental terms and how consciousness can be built
in the human brain. I do not claim to have solved the problem of
consciousness, and in the current state of the history of cognitive
science and neuroscience, despite some substantial new insights, I
am somewhat skeptical of the idea of solving the problem of
consciousness. I just hope that the ideas I present here contribute to
the possible resolution of the problem of being from a biological
perspective.6
The text is based on a research program, currently under way,
which in turn is supported by various lines of research activity,
reflecting facts glimpsed in many years of observation of neurology
patients with mental and behavioral disorders and in discoveries made
in experimental neuropsychological studies on such disorders; in
theorizing about the processes of consciousness as they occur in the
normal human condition, using the evidence of general biology,
neuroanatomy and neurophysiology; and in the design of testable
hypotheses regarding the neuroanatomical bases of consciousness
obtained from reflection and theory.
FOCUS OF CONSCIOUSNESS
Before proceeding further it is necessary to say a few words

about how to approach the problem we have defined. It would be
nice, of course, if the contents of our minds were even more
overlapping than they are, so that I could write this book in parallel
columns and you
could simultaneously read questions about theoretical assumptions,

scientific methods, and basic facts. But we function in the world of
classical physics and I must resort to the tricks of the Elizabethan
age: asides and digressions. I promise to be brief and stick to the
essentials.
Mind, behavior and brain
Consciousness is a completely private, first-person singular

phenomenon that occurs as part of the private, first-person singular
process we call mind.7 However, consciousness and mind are
closely linked to external behaviors that can be observed by third
parties.
All of us share these phenomena (mind, consciousness within the
mind and behaviors) and we know quite well how they interrelate,
firstly because of our analysis of ourselves and secondly because of
our natural propensity to analyze others. Both the wisdom and the
science of the human mind and behavior are based on this
incontrovertible correlation between the private and the public: mind
in the first person, on the one hand, and behavior in the third person,
on the other. Fortunately for those of us who also want to understand
the mechanisms underlying mind and behavior, it just so happens
that mind and behavior are also closely related to the functions of
living organisms, and specifically to the functions of the brain of
those organisms. .8 The power of this triangulation between mind,
behavior and brain has been evident for more than a century and a
half: since the neurologists Paul Broca and Carl Wernicke discovered
the connection between language and certain regions of the brain's
left hemisphere. This triangulation has allowed a most fortunate
development: the traditional worlds of philosophy and psychology
have gradually joined forces with the world of science.
of biology and have created a strange but productive alliance. For

example, through that loose federation of scientific approaches now
called cognitive neuroscience, the alliance has enabled new advances
in understanding vision, memory, and language. There are good
reasons to hope that the alliance will also provide the understanding
of consciousness.
In the past two decades, work in cognitive neuroscience has
been especially rewarding because the development of new
techniques for observing the brain, both in structure and function,
allows us today to link certain observed behaviors, either clinically or
experimentally, not just with the supposed replication of such behavior
but with concrete indices of brain structure or brain activity.
Let me offer some examples. Areas of restricted brain damage

caused by neurological disease, known as lesions, have long been a
cornerstone of research on the neural basis of the mind. These
lesions often appeared only at the time of autopsy, usually many
years after the patient's study had been completed. That time lapse
delayed the analysis process and generated uncertainty about the
correlation between anatomy and behavior. However, recent technical
advances allow us to analyze lesions in a three-dimensional
reconstruction of the living patient's brain at the same time as
cognitive or behavioral observations are made. The reconstruction is
presented on a computer screen and is based on painstaking
manipulation of raw data obtained from an MRI scanner. It depicts
neural structures with high fidelity and allows careful dissection in
virtual space rather than on the lab bench.
The importance of this advance is that a lesion analyzed in such a

detailed and timely manner serves as a demonstration of hypotheses
about how the brain system executes certain
mental functions or behaviors. We can postulate, for example, that a

system made up of four connected brain regions, A, B, C, and D,
functions in a certain way. We can then predict the type of changes
that should occur when, for example, the C-region is destroyed. To
test the validity of the prediction, we study how patients with a lesion
in the C-region behave while performing a certain task. Incidentally,
this same approach is used in another recently emerged area of
neuroscience, molecular neurobiology. A particular gene is
experimentally inactivated, in a mouse, for example, thus causing an
"injury" (in scientific jargon this is called a "KO"). Investigators can
then determine the consequences of the "KO" as predicted.9
Another example of a new type of brain index is the area of

increased or decreased brain activity, which is revealed by positron
emission tomography (PET) scanning or functional magnetic
resonance imaging (fMRI) scanning. These scanners can be used
not only in neurological patients but also in humans without brain
diseases. And here again a particular prediction regarding the activity
of a certain region during the performance of a certain mental task is
used to calculate the validity of the hypothesis.
Another index is the change in electrical conductivity measured

in the skin; o the change in electrical potentials and their magnetic
fields measured on the scalp; or the change in electrical potentials
measured directly on the brain surface during surgical treatment of
epilepsy. It is remarkable that the possibility of establishing intricate
links between the private mind, public behavior and brain function
does not stop with the application of these new techniques. The
intertwined links can be extended through a connection to new
domains of knowledge about the anatomy and function of the nervous
system, explored by neuroanatomists, neurophysiologists,
neuropharmacologists, and neurobiologists who
they study molecular events within individual nerve cells and which,
in turn, can relate these to the composition and action of particular
genes. The facts that have recently emerged on the basis of all these
advances allow us to establish progressively more detailed theories
that deal with the relationship between certain aspects of the mind,
behavior and the brain. The organism's private mind, its public
behavior, and its hidden brain can thus be brought together in the
adventure of theory, out of which hypotheses emerge that can be
experimentally tested, judged on their merits, and consequently
adopted. rejected or modified. (See the appendix on the basics of
brain anatomy and organization.)
Reflection on neurological and neuropsychological evidence
The results of neurological observations and neuropsychological

experiments reveal many facts that have been the starting point for
the ideas presented here. The first fact is that some aspects of
consciousness processes can be related to the functioning of certain
brain systems and regions, thus opening the door to the discovery of
the neural architecture that underpins consciousness.
The systems and regions in question accumulate in a limited set of

brain territories and there will be an anatomy of consciousness in the
same way that there is for functions such as memory or language.
One of the purposes of this text is to present testable anatomical
hypotheses for certain aspects of the process of consciousness.
The second fact is that awareness and wakefulness can be

separated, as well as low-intensity awareness and attention. This fact
is based on the evidence that there are patients who may be
awake and attentive without having normal consciousness, as exemplified

by the man in the circular classroom. In Chapters 3 and 4 I consider such
patients and discuss the theoretical importance of their condition.
The third fact, and perhaps the most revealing, is that consciousness
and emotion are not separable. As discussed in Chapters 2, 3, and 4, the
usual case is that when consciousness deteriorates, so does emotion.
Indeed, the connection between emotion and consciousness, on the one
hand, and between both and the body, on the other, form the main theme of
this book.
The fourth fact is that consciousness is not monolithic, or at least not in
humans: it can be sliced into simple and complex types, and neurological
tests make this slice transparent. The simplest type, what I call central
awareness, gives the organism a sense of being at a time (the now) and in
a place (the here). The scope of core consciousness is the here and now.
The central consciousness sheds no light on the future, and the only past it
gives us a vague glimpse of is the one that happened an instant before.
There is no other place, there is no before, there is no after. On the other
hand, the complex type of consciousness, which I call extended
consciousness and of which there are many degrees and levels, provides
the organism with an elaborate sense of being (an identity and a person,
you or me, no less) and situates the person at a point in historical time,
deeply aware of the lived past and the anticipated future and keenly aware
of the world around him.
In short, central consciousness is a biological phenomenon; it has a

single level of organization; it is stable throughout the life of the organism; it
is not uniquely human and does not depend on conventional memory,
working memory, reasoning or language. On the other hand, expanded
consciousness is a complex biological phenomenon; It has various levels of
organization and develops throughout the life of the organism.
Although I believe that expanded consciousness is also found in some non-

humans, at its simplest levels it only reaches its
higher levels in humans. It depends on conventional memory and active

memory. When it reaches its human culmination, it is also reinforced by
language.
The supersensation of central consciousness is the first exit on the
scene of knowing and does not shed light on the complete being as such.
On the other hand, the suprasensation of the expanded consciousness
ends up producing a complete construction of being on stage. In
expanded consciousness, both the past and the anticipated future are
felt together with the here and now, in a panorama of epic scope.
If it is true that the central consciousness is the rite of passage for

knowing, it is also equally true that the levels of knowing that allow human
creativity are those that only the expanded consciousness admits. What
we think of when we think of the glory of consciousness, and when we
think of consciousness as distinctively human, is consciousness expanded
at its zenith. And yet, as we shall see, the extended consciousness is not
an independent variety of consciousness: on the contrary, it is built on
the foundation of the central consciousness. The fine scalpel of
neurological disease reveals that damage to extended consciousness
allows central consciousness to remain untouched. On the other hand,
the damage that begins in the central consciousness completely
demolishes the edifice of consciousness: then the expanded
consciousness also collapses. That glory of consciousness demands an
orderly increase of both kinds of consciousness. But if we want to clarify
this glorious combination, we would do well to begin by understanding
the simplest type of consciousness that serves as the foundation: the
central consciousness.10 Indeed, the two types of consciousness
correspond to two types of being. The sense of self that arises from
central awareness is the central self, a transient entity, endlessly re-
created for each and every object the brain engages with. However,
our traditional notion of being
it is linked to the idea of an entity and corresponds to a collection of

unique and non-transient facts and ways of being, a collection that
characterizes a person. The term I use for that entity is to be
autobiographical. The autobiographical being depends on the
systematized memories of the various situations in which the central
consciousness was involved in that knowledge of the invariant
characteristics of the life of an organism: from whom we were born,
where and when, what we like and what we hate, how we usually
react to a problem or a conflict, what we call ourselves and so on. I
use the term autobiographical memory to designate the ordered
recording of the main aspects of the biography of an organism. These
two types of being are related, and in chapter 6 I explain how the
autobiographical being emerges from the central being.
A fifth fact: It is not uncommon for consciousness to be explained

simply as a set of cognitive functions such as language, memory,
reason, attention, and working memory. While such functions are
undoubtedly necessary for the higher levels of expanded
consciousness to function normally, the study of neurological patients
seems to indicate that they are not essential to central consciousness.
By the same token, a theory of consciousness should not be just a

theory of how memory, reason, and language contribute to the top-
down construction of an interpretation of what goes on in the brain
and mind. Certainly memory, intelligent inferences and language are
essential for the generation of what I call autobiographical being and
for the process of expanded consciousness. Surely some interpretation
of events occurring in an organism can be obtained once the process
of autobiographical self and expanded consciousness is in place. But
I don't think that consciousness began that way, at that high level of
the hierarchy of cognitive processes and so late in the history of life
and of each one of us. What I maintain is that the most primitive forms
of consciousness precede
to inferences and interpretations: they are part of the biological

transition that ends up allowing inferences and interpretations. For
the same reason, a theory of consciousness should account for the
simplest and most basic phenomenon that occurs almost as a non-
conscious representation of the organism for which all this function
is represented and which, in turn, can support later advances in
consciousness. identity and person.
Furthermore, a theory of consciousness should not simply be a
theory about how the brain attends to the image of an object. As I
understand it, low-intensity attention precedes awareness, while
focused attention follows the development of awareness. Attention is
as necessary for consciousness as having images. But attention is
not enough for awareness and it is not the same as awareness.
Finally, a theory of consciousness should not be just a theory

about how the brain creates integrated and unified mental scenes,
although the production of integrated and unified images is an
important aspect of consciousness, especially at higher levels. Those
scenes do not exist in a vacuum.
I believe that they are integrated and unified due to the singularity of
the organism and for the benefit of that singular organism. The
mechanisms that trigger the integration and unification of the scene
require an explanation.
Focusing on the explanatory efforts on how the feeling of being
appears in the mind in the act of knowing an object, I am open to the
criticism that I limit myself to addressing the problem of so-called
self-awareness and that I neglect the rest of the problem, namely ,
the problem of qualia. I would respond to this review with the
following. If 'self-consciousness' is understood as 'consciousness
with a sense of being' then the term necessarily encompasses all
human consciousness: as far as I can see, there is no other kind of
human consciousness. I would add that the biological state we
describe as a sense of being and the biological machinery
responsible for engendering it may well lend a hand in optimizing the

processing of the objects to be known: having a sense of being is not
only required to know in the strict sense, but can influence the
processing of what is to be known. In other words, the biological
processes that pose the second problem of consciousness probably
play a role in the biological processes that pose the first. When I
address the problem of being, I am addressing the issue of qualia in
relation to the representation of the organism that has consciousness.11
SEARCH FOR THE SELF
How do we know that we are seeing a certain object?

How do we become conscious in the full sense of the word? How is
that feeling of being implanted in the mind, in the act of knowing?
The path to a possible answer to the questions about being only
opened up once I began to pose the problem of consciousness on
the basis of two key actors, organism and object, as well as on the
relationships that these actors maintain in the course of their natural
interaction. The organism in question is the one within which
consciousness occurs; the object in question is any object that
becomes known in the process of consciousness; and the relations
between organism and object are the contents of knowledge which
we call consciousness.
From this perspective, consciousness consists in constructing the
knowledge of two facts: that the organism is in relationship with some
object and that the object of that relationship causes some change in
the organism.
This new perspective also turns the biological concretion of
consciousness into an approachable problem. The process of
knowledge construction requires a brain and requires the telltale
properties with which brains can organize
neural patterns and form images. The neural patterns and images
necessary for consciousness to arise are those that constitute
features of the organism, the object, and the relationships between
the two. In this context, understanding the biology of consciousness
becomes a question of discovering how the brain can map both the
two actors and the relationships between them.
The general problem of representing the object is not particularly

puzzling. Extensive studies of perception, learning and memory, as
well as language, have provided us with a workable idea of how the
brain processes an object, both sensory and motor, as well as an
idea of how it can be stored in memory. memory the knowledge of
an object, categorized in linguistic and conceptual terms, to be
retrievable as a thing recognized or remembered. The
neurophysiological details of these processes have not yet been
discovered, but the contours of these problems are now
understandable.
In my view, neuroscience has devoted most of its efforts to
understanding the neural basis of what seems to me to be an "object
feature." In the play of relations of consciousness, the object appears
in the form of neural patterns in the appropriate sensory cortices to
map its characteristics. For example, in the case of the visual aspects
of an object, neural pathways are found in various regions of the
visual cortices, not just one or two but many, working in concert to
map the various aspects of an object in turn. with regard to its visual
features.12 However, on the part of the organism things are very
different. To indicate how very different things are, let me suggest an
exercise.
Look up from this page and look at what is right in front of you,
look at it carefully, and then look at the page again. In doing so, the
many elements of your visual system, from the retinas to the various
regions of your cerebral cortex, have passed almost
instantly from mapping the page of the book to mapping the room in
front of you to mapping the page again. Now turn 180º and look at
what is behind you. Again the mapping of the page fades very quickly
so that the visual system can map the new scene you are looking at.
Takeaway: In rapid succession, the same brain regions build
completely different maps by virtue of the different motor sites the
organism supplies and the different sensory inputs the organism
gathers. The image built on the multiple screens of the brain changes
remarkably.
Now consider this: As your visual system obediently changed at

the mercy of the objects it mapped, a number of regions in your brain
whose job it is to regulate life processes and which house previous
maps representing different aspects of your body, they do not change
at all in terms of the type of object represented. The body remains
the object and remains so until death arrives. But not only is the type
of object exactly the same; the degree of change that occurs in the
object (in the body) has been quite small. Why's that? Because only
a narrow range of bodily states is compatible with life, and because
the organism is genetically designed to maintain that narrow range
and is equipped to seek it no matter what.
What we have in this situation, then, is an intriguing asymmetry

that can be formulated in the following terms: some parts of the brain
are free to roam the world and in doing so are free to map whatever
their design as an organism allows them to do. On the other hand,
some other parts of the brain, those that represent the organism's
own state, are not free to roam. They are fixed. They cannot map
anything other than the body and that mapping
carried out on already mapped maps for the most part. They are the
captive audience of the body and are at the mercy of the body's
dynamic sameness.
There are several reasons for this asymmetry. First, the
composition and general functions of the living body remain the same,
in quality, throughout life.
Second, the bodily changes that occur continuously are small in
number. They move in a narrow dynamic range because the body
must function within a limited range of parameters if it is to survive;
the internal state of the body must be relatively stable compared to
that of the surrounding environment. Third, that steady state is
governed by the brain through complex neural machinery designed
to detect minute variations in the parameters of the body's internal
chemical profile and to order actions to correct those variations that
are detected, directly or indirectly.
(I will cover the neuroanatomy of this system in Chapter 5. The

system is made up of not one but many units, the most important of
which are found in the brainstem, hypothalamus, and anterior basal
sections of the brain.) brain.) In short, the organism of the interplay of
consciousness is the entire unit that is our living being, our body so
to speak; and yet, as it turns out, the part of the body we call the brain
has within it a kind of model of the whole. This is a rare and often
overlooked but noteworthy fact, and may be the single most important
clue to the possible basis of consciousness.
I have come to the conclusion that the organism, as represented

in our own brains, is a possible biological precursor to that which is
the elusive sense of being. The deep roots of being, including the
complex being that encompasses identity and personality, are to be
found in the array of brain artifacts that continually unconsciously
maintain the state of the living body within range.
narrow and relative stability required for survival. These artifacts

continuously, unconsciously represent the state of the living body
along with its multiple dimensions. I call the state of activity within the
set of such artifacts protoser, the biological precursor of those levels
of being that appear in our minds as conscious protagonists of
consciousness: the central being and the autobiographical being.
In case some readers are concerned at this point that I am

stepping into the abyss of the homunculus trap, let me say immediately
and vehemently that this is not the case. The "body-in-brain model" I
am referring to has nothing to do with the rigid homunculus creature
of old-fashioned neurology textbooks. It doesn't look like a little person
inside a big person at all; the model "perceives" nothing and "knows"
nothing: it neither speaks nor manufactures consciousness. On the
contrary, the model is a collection of brain artifacts whose main task
is the automatic maintenance of the life of the organism. As we will
discuss later, the maintenance of life is achieved through a variety of
innate regulatory actions: secretion of chemicals, such as hormones,
as well as movements of internal organs and limbs. The deployment
of such actions depends on the information provided by nearby neural
maps that indicate, moment by moment, the state of the entire
organism. More importantly, neither life's regulatory artifacts nor their
body maps are the generators of consciousness, although their
presence is indispensable to the mechanisms that do achieve central
consciousness.
This is the key issue, as chapter 5 argues: in the interplay of

consciousness, the organism is abundantly and variegatedly
represented in the brain, and that representation is tied to the
maintenance of the life process. Yes
this idea is correct, life and consciousness, and especially the question
of being in consciousness, are inextricably intertwined.
WHY WE NEED AWARENESS
If you find the connection between life and consciousness

surprising, consider the following. Survival depends on the discovery
and incorporation of energy sources, and on the prevention of all
kinds of situations that threaten the integrity of living tissues. It is true
that without actions, organisms like ours would not survive, since the
energy sources required to renew the structure of the organism and
maintain its life could not be found and mastered to put them at the
service of the organism, not to mention the environmental dangers .
But by itself, without the guidance of images, the actions would not
take us very far.
Good deeds need the company of good images. The images allow us
to select between the different repertoires of previously available
action patterns and optimize the execution of the chosen action: in a
more or less deliberate or automatic way, we can mentally review the
images that represent different possibilities of action, different
situations, different results. of those actions.
We can pick and choose the most suitable and reject the worst.
Images also allow us to invent new actions to apply to novel situations
and to set up plans for future actions: the ability to transform and
combine images of actions and scenarios is the source of creativity.
If actions are at the root of survival and if their power is linked to

the availability of guiding images, it follows that a device capable of
maximizing the effective manipulation of images in the service of the
interests of an organism
concrete would provide enormous advantages to organisms

possessing such an artifact and would probably prevail in evolution.
Consciousness is precisely such an artifact.
The groundbreaking novelty provided by consciousness was to
enable the connection between the sancta sanctorum of vital
regulation with the processing of images. In other words, it was about
the possibility of getting the regulatory system of life (which is housed
in the depths of the brain, in regions such as the brain stem and the
hypothalamus) to refer to the processing of images that represent
things. and the events that exist inside and outside the organism. And
why should this be a real advantage? Because survival in a complex
environment, i.e. efficient regulation of life support, depends on taking
the right action, and in turn can be greatly enhanced by purposeful
trailering, image manipulation and optimal planning. Consciousness
enabled the connection between these two disparate aspects of the
process: inner vital regulation and image-making.
Consciousness generates the knowledge that images exist within

the individual who forms them, places them in the perspective of the
organism by attributing those images to an integrated representation
of the organism, and in doing so allows the manipulation of images
for the benefit of the organism. When it appears in evolution,
consciousness heralds the rise of individual foresight.
Consciousness opens the possibility of constructing in the mind

a replica of the hidden regulatory specifications in the central brain, a
new way for the vital impulse to present its demands and for the
organism to satisfy them. Consciousness is the rite of passage that
enables an organism armed with the ability to regulate its metabolism,
innate reflexes, and the form of learning called conditioning, to
become a mental organism, a type of organism in which responses
are shaped. according to a mental preoccupation with one's own
organism life. Spinoza said that the effort to preserve oneself is the
first and only foundation of virtue.13 Consciousness is what allows
such an effort.
THE BEGINNING OF CONSCIOUSNESS
Once I figured out how the brain could put together the patterns
that represent an object and those that represent the organism, I
began to puzzle over what mechanisms the brain might use to
represent object-organism relationships to itself. Specifically, what I
was looking for was how the brain could represent the fact that when
an organism is busy processing an object, the object causes the
organism to react and, in reacting, to change state. A possible solution
is presented in chapters 6, 7 and 8. What I am suggesting is that we
become conscious when the representational artifacts of the organism
exhibit a specific type of non-verbal knowledge (the knowledge that
the organism's own state has been changed by the object) and when
such knowledge occurs in conjunction with the salient representation
of an object. The sense of being in the act of knowing an object is an
infusion of new knowledge, continuously created within the brain
whenever "objects," present or remembered, interact with the
organism and cause it to change.
The sense of being is the first answer to a question never posed

by the organism: Who owns the mental patterns that form and unfold?
The answer is that they belong to the organism, represented in the
protoser. I show later how the brain marshals the nonverbal knowledge
necessary to produce this unsolicited response. However, I can say
at this point that the easiest way for this non-verbal knowledge to
arise mentally is the sense of knowing (the sense of what happens
when an organism deals with itself).
process an object) and that only from then on can inferences and
interpretations begin to occur in relation to the sensation of knowing.
Curiously, consciousness begins as a sensation of what happens

when we see, hear or touch. Said with somewhat more precise words,
it is a feeling that accompanies the fabrication of any type of image
(visual, auditory, tactile, visceral) within our living organism. Placed in
the proper context, that feeling registers those images as images of
ourselves and allows us to say, in the strict sense of the terms, what
we see, hear or touch. Organisms that are not prepared to generate
a central consciousness are condemned to fabricate images of sight,
sound, or touch, here and now, but they cannot know that they have
done such a thing. From its humblest beginnings, consciousness is
knowledge and knowledge is consciousness, as intertwined with each
other as truth and beauty were for Keats.
FACE THE MYSTERY
There has been a lack of agreement among those who study the
problem of consciousness, not only about what consciousness is but
also about the prospects for understanding its biological basis.
There has also been some confusion, and even concern, among
those who are not students of consciousness, but simply everyday
users, about the human consequences of clarifying the biology of
consciousness. For some non-specialists, consciousness and mind
are practically indistinguishable, as are consciousness and spirit,
consciousness and soul, consciousness and being aware. For them,
and perhaps for you, the mind, the conscience, the consciousness,*
the soul and the spirit form a vast region of the strange that makes
humans a group apart, separating the mysterious from the uncanny.
explainable and the sacred from the profane. It should not come as a
surprise to discover that how to deal with this sublime combination of
human properties matters greatly to any sensible human being and
that he may even be offended by apparently contemptuous
explanations of its nature. Anyone who has faced death will know
precisely what I mean, surely because the irreversibility of death
makes us fix our thoughts very insistently on the monumental scale
of human mental life. However, death should not be necessary for
anyone to become sensitive to this issue. Life should be enough to
make us focus the human mind with respect for its dignity and stature
and, almost paradoxically, with tenderness for its fragility.
Anyway, let me clarify one thing. Science helps us make

distinctions between phenomena, and science can now distinguish
with certainty the various components of the human mind.
Consciousness and consciousness are certainly distinguishable:
consciousness corresponds to knowing that any object or action is
attributable to a being, while consciousness refers to the goodness or
badness found in acts and objects. Consciousness and mind are
likewise distinguishable: consciousness is the part of the mind related
to the apparent sensation of being and knowing. In the mind there is
something more than consciousness and there can be a mind without
consciousness, as we discover in patients who have one but not the
other.
In its advance, science proposes explanations for the phenomena
that it can distinguish. In the case of the mind, it can explain parts of
that vast region of the strange. It collects some mechanisms
underlying some phenomena that contribute to the creation of the
admirable human mind that we respect so much.
Yet this admirable creation does not vanish just because we can
explain some of the component mechanisms necessary for it to
happen. Appearance is reality: the human mind as we feel it. When
we explain the mind
we learn to preserve that reality while satisfying part of our curiosity by

looking at the skill behind that appearance.
There is another matter that I must make clear: solving the

mystery of consciousness is not the same as solving all the mysteries
of the mind. Consciousness is an indispensable ingredient of the
human creative mind, but it is not the entire human mind and, in my
opinion, it is not the pinnacle of mental complexity. The biological tricks
that give rise to consciousness have powerful consequences, but I
see consciousness as an intermediary rather than the culmination of
biological development. Ethics and law, science and technology, the
work of the muses and the milk of human goodness: these are my
high points for biology. Naturally we would have none of them without
the wonders of consciousness at the origin of all new achievement.
But, nevertheless, consciousness is a sunrise, not a full day, much

less a sunset. Understanding consciousness says little or nothing
about the origins of the universe, the meaning of life, or the probable
fate of both. After solving the mystery of consciousness and getting
your teeth into a few related mysteries of the mind, assuming science
does both, there are enough mysteries left to fill many a scientist's
lifetime, enough awe of nature to remain modest for the foreseeable
future.
After considering how consciousness can be produced within a pound

and a half of meat called the brain, surely we will respect life and
human beings more, not less.
HIDE AND SEEK
Sometimes we use the mind not to discover facts but to hide

them. We use part of the mind as a screen to prevent another part of
the mind from knowing what is happening.
Over there. This concealment is not necessarily intentional (not

deliberate concealers but deliberately or notconstantly),
the concealment
we areoccurs.
One of the things that this screen hides most effectively is the
body, our own body, a word with which I want to indicate its interiorities.
Like a veil placed over the skin to ensure its modesty, though not quite
so perfectly, the screen partially shields the mind from the internal
states of the body, those that constitute the flow of life as it moves
through each day.
The supposedly vague, elusive and intangible character of

emotions and feelings is surely a symptom of this fact, an indication
of how much we cover up the representation of our body, how much
mental imagery based on disembodied objects and events masks the
reality of the body. Sometimes we use the mind to hide a part of our
being from another part of our being.
I could describe the concealment of the body as a distraction, but

I would have to add that it is an adaptive distraction.
In most circumstances, instead of concentrating resources on our
internal states, it may be more advantageous to concentrate them on
images that describe problems around us or on the premises of those
problems or on the options to solve them and on their possible
outcome. However, this bias in perspective relative to what the mind
has at its disposal comes at a cost. It tends to prevent us from
detecting the possible origin and possible nature of what we call being.
However, when the veil is lifted on the scale of understanding allowed
to the human mind, I think we will be able to detect the origin of that
construct we call being in the representation of individual life.
It may have been easier to get a more balanced perspective in

earlier days when there was no veil, when the environment was
relatively simple, long before electronic gadgets and jet flights, long
before the word
written, long before empires and city-states.

It must have been easier to grasp the inner life when the brain
produced a view skewed in the opposite direction, biased toward the
dominant representation of the internal states of the organism. Had it
ever been so, it may be that in a brief time between Homer and
Athens, the lucky humans could perceive in an instant that all their
amusing antics were about life, and that beneath all the images of the
outside world was the progressive image of God. their living bodies.
Or they may not have perceived as much since they lacked the frame
of reference provided by current knowledge of biology. Be that as it
may, I suspect that they were able to perceive more about themselves
than we, unseen, are capable of perceiving today. I marvel at the
ancient wisdom of referring to what we now call mind with the word
psyche, which was also used to indicate breath and blood.
What I am suggesting is that the highly constrained ebb and flow

of internal states of the organism, innately controlled by the brain and
continuously signaled to the brain, forms the background of the mind
and, more specifically, is the foundation of that mind. elusive entity
that we call being. I also suggest that these internal states (which
occur naturally between the two poles of pain and pleasure, and
which are caused by both internal and external objects and events)
become involuntary nonverbal signifiers of goodness or badness. of
the situations related to the set of values inherent to the organism. I
suspect that in the early stages of evolution, these states (including
those we classify as emotions) were completely unknown to the
organisms that produced them.
Those states regulated and that was enough: they produced some
advantageous actions, both internally and externally, or they indirectly
contributed to the production of such actions by making them more
favorable. But the agencies that carried out these complicated
operations knew nothing about the
existence of such operations and actions, given that they did not even
have a notion, in the strict sense of the word, of their own existence
as individuals. True, organisms had brains and bodies, and brains
had a certain representation of the body. Life was there and so was
the representation of life, but the potential and full owner of each
individual life had no notion that life existed because nature had not
yet invented the owner. There was being but not knowing.
Consciousness had not started.
Consciousness begins when the brain acquires the capacity, the

simple capacity I would say, to tell a story without words, the story
that tells that there is life in an organism and that the states of that
living organism, within the bodily borders, are seen. continually altered
by encounters with objects or events in their environment or, for that
matter, by thoughts and internal adjustments to the life process.
Consciousness arises when this primordial story (the story of an
object causally changing the state of the body) can be told using the
universal nonverbal vocabulary of body signals. The apparent being
arises as the feeling of a feeling. When the story is first told,
spontaneously, without even asking for it to be told, and then when
the same story is endlessly repeated, knowledge about the life of the
organism automatically arises as an answer to a question that has
not been asked. From that moment, we begin to know.
I suspect that consciousness prevailed in evolution because

knowing the sensations caused by emotions was indispensable to
the art of life and because the art of life has been unmatched in the
history of nature. But I wouldn't mind if you preferred to twist my
words and simply say that consciousness was invented so that we
could know life. Its formulation is not scientifically correct, of course,
but I like it.
SECOND PART
FEEL AND KNOW

CHAPTER TWO
EMOTION AND SENSATION
EMOTIONS, ONCE AGAIN
Without exception, men and women of all ages, cultures,

education levels, and all manner of economies have emotions, are
attentive to the emotions of others, cultivate hobbies that manipulate
their emotions, and run their lives in no small measure by the pursuit
of an emotion, happiness, and the avoidance of unpleasant emotions.
At first glance, there is nothing distinctively human about emotions,
since there are clearly so many non-human creatures who have
emotions in abundance; And yet there is something quite distinctive
about how emotions have been connected to complex ideas, values,
principles, and judgments that only humans experience: and in that
connection lies our legitimate sense that human emotion is special.
Human emotion is not just about sexual pleasures or the fear of
snakes. He also speaks of the horror of contemplating suffering and
of the satisfaction provided by the administration of justice; of the
delight produced by Jeanne Moreau's sensual smile or of the dense
beauty of words and ideas in Shakespeare's verses; of the tired voice
of Dietrich Fischer-Dieskau singing Bach's Ich habe genug and of
the earthy and at the same time ethereal phrasing of Maria João Pires
when she plays anything by Mozart or Schubert; and the harmony that
Einstein was looking at an equation. In fact, fine human emotion is

triggered even by cheap music and movies, the power of which
should never be underestimated.
The human impact of all the causes of emotion mentioned above,
refined or not so refined, and all the nuances of emotion they induce,
subtle or not so subtle, depends on the sensations those emotions
engender. It is through sensations, which are private and directed
inward, that emotions, which are public and directly directed outward,
begin their impact on the mind; but the full and lasting impact of
sensations requires awareness because only with the arrival of a
sense of being do they become known to the individual experiencing
them.
Some readers may be puzzled by the distinction between

"feeling" and "knowing that we feel." Does not the state of feeling
necessarily imply that the sensing organism is fully aware of the
unfolding emotion and sensation? What I am suggesting is that no,
that an organism can enact in mental and neural patterns the state
that we conscious creatures call sensation without even remotely
knowing that such a sensation is taking place. This separation is
difficult to imagine, not only because the traditional meanings of the
words block the image, but because we tend to be aware of our
sensations. However, there is no evidence that we are aware of all
our sensations and many that seem to indicate that we are not. For
example, we tend to become aware quite suddenly that in a given
situation we feel anxious or uncomfortable, pleased or relaxed, it
being apparent that the particular state of feeling that we know then
has not begun at the moment of knowing but some time before.
Neither the state of feeling nor the emotion that has led to it have
been in "consciousness" and yet have developed as biological
processes. These distinctions may seem artificial at first glance,
although my
The purpose is not to complicate the simple, but rather to chop up

something that is quite complicated into manageable parts. For the
purpose of investigating these phenomena, I divide this continuum into
three stages of processing: a state of emotion, which can be triggered
and executed unconsciously; a feeling state, which can be represented
unconsciously; and a state of sensation made conscious, that is,
known to the organism that has the emotion and sensation. I think
these distinctions are useful when we try to imagine the neural basis
of this chain of events in humans. What's more, I suspect that some
nonhuman creatures that show emotions but surely don't have the
kind of consciousness that we do, might well enact the representations
we call emotions without knowing that they do so. Someone might
point to the idea that surely we should have another word for these
"sensations that are not conscious," but we don't.
Our closest alternative to it is to explain what we mean by such a thing.
In short, consciousness must be given if the sensations are to

influence beyond the immediate here and now the subject who has
them. The importance of this fact, that the ultimate consequences of
human emotion and sensation pivot on consciousness, has not been
fully appreciated (possibly to blame for the strange history of research
on emotion and sensation to which it relates). I mean later). Emotion
probably appeared in evolution before the dawn of consciousness and
surfaces in each of us as a result of certain inducers that we do not
always consciously recognize; on the other hand, sensations exert
their definitive and lasting effects in the theater of the conscious mind.
The stark contrast between the covert induction and outward

stance of emotion, and the definitively known, inwardly directed status
of human sensation provided me with an invaluable perspective for
reflecting on the biology of emotion.
awareness. And there are other bridges between emotion and consciousness.
In this book my idea is that consciousness, like emotion, is directed to the
survival of the organism and that, like emotion, consciousness is rooted in the
representation of the body. I also draw attention to an intriguing neurological
fact: when consciousness is suspended, from central consciousness upwards,
emotion is often suspended as well, as if to indicate that although emotion
and consciousness are different phenomena, their respective bases may well
be different. be connected. For all of these reasons it is important to discuss
the various features of emotion before we begin to address consciousness
directly. But first, before outlining the results of that reflection, I propose a
digression on the strange history of the science of emotion, since that history
may help explain why consciousness has not been approached from the
perspective I take here.
A historical digression
Given the magnitude of the issues to which emotion and sensation have
been linked, one would expect that both philosophy and the sciences of the
mind and brain would have embarked on their study. Surprisingly, it is only
happening now. Philosophy, apart from David Hume and the tradition that
begins with him, has mistrusted the emotions and has generally relegated
them to the despicable realms of the animal and the flesh. For a time science
made some further progress, but then it too lost its chance.
By the end of the 19th century, Charles Darwin, William James, and
Sigmund Freud had written extensively on different aspects of emotion, giving
it a privileged place in scientific discourse. However, throughout the 20th
century and until recently, both neuroscience and cognitive science gave
side to emotions. Darwin developed a very extensive study of the

expression of emotions in different cultures and in different species
and although he believed that human emotions were vestiges of
previous stages of evolution, he was respectful of the importance of
the phenomenon. William James tackled the problem with
characteristic insight and offered an explanation that, though
incomplete, remains a cornerstone.
As far as Freud was concerned, he glimpsed the pathological potential
of disturbed emotions and announced their importance in no uncertain
terms.
Darwin, James, and Freud were necessarily vague about the
cerebral approach to their ideas, but one of their contemporaries,
Hughlings Jackson, was more precise. He took the first step towards
a possible neuroanatomy of emotions and suggested that the right
hemisphere of humans was probably the dominant one in emotions,
just as the left one was dominant in language.
It would have been logical to expect that, as the new century

dawned, the expanding brain sciences would put emotions on their
agenda to resolve the questions they raised. But such a development
never took place. What is worse, Darwin's work on the emotions
faded away, James's proposal came under unwarranted attack, being
summarily dismissed, and Freud's influence shifted to other issues.
For much of the 20th century, emotions were not entrusted to the
laboratory. Emotions were said to be too subjective. Emotions were
too slippery and vague. Emotions were at the opposite pole from
reason, easily recognized as the most human capacity and presumed
to be completely independent of emotions.
It was a wicked twist from the romantic approach to humanity. The

romantics had placed emotions in the body and reason in the brain.
Twentieth- century science put aside the body and put emotions back
in the brain.
albeit relegating them to the lower neural stratum, associated with

ancestors whom no one revered. Ultimately not only was the emotion
not rational, its study probably wasn't either.
There are some curious parallels with the scientific abandonment

of emotions during the 20th century. One of them is the lack of an
evolutionary perspective in the study of the brain and the mind. It
may be an exaggeration to say that neuroscience and cognitive
science have advanced as if Darwin never existed, but until this last
decade it has seemed that way. Aspects of the brain and mind have
been discussed as if they were newly designed, as needed to produce
a certain effect (as if putting ABS on the brakes of a brand new car),
without bothering to look for no possible antecedents between brain
and mental artifacts. This situation is changing a lot lately.
Another parallel concerns the neglect of the notion of homeostasis.

Homeostasis refers to the coordinated and largely automatic
reactions that are necessary to adequately maintain the internal
states of a living organism. Homeostasis describes the automatic
regulation of our body's temperature, oxygen concentration, or pH.
Numerous scientists have been concerned with understanding the
neurophysiology of homeostasis, making it compatible with the
neuroanatomy and neurochemistry of the autonomic nervous system
(the part of the nervous system most directly concerned with
homeostasis), as well as clarifying the interrelationships of the
autonomic nervous system. endocrine, immune and nervous systems,
whose coordinated functioning produces homeostasis. But scientific
progress in these areas has had little influence on prevailing ideas
about how the mind and brain work. It is curious that emotions are art
and part of that regulation that we call homeostasis. There's no point
in debating
about them without understanding that aspect of living organisms, or

vice versa. In this book, what I propose is that homeostasis is one of
the keys to the biology of consciousness (see Chapter 5).
A third parallel is the notable absence of a notion of organism in
cognitive science and in neuroscience. The mind remained linked to
the brain in a somewhat equivocal relationship, and the brain remained
persistently separate from the body rather than seen as part of a
living organism. The notion of the integrated organism (the idea of a
whole made up of a suitable body and a nervous system) was present
in the work of thinkers such as Ludwig von Bertalanffy, Kurt Goldstein,
and Paul Weiss, but had little impact on the formation of standard
conceptions. of the mind and the brain.1 There are of course
exceptions to this sketchy picture.
For example, Gerald Edelman's theoretical proposals on the neural

basis of the mind are informed by evolutionary thought and by the
recognition of homeostatic regulation; and my somatic marker
hypothesis is grounded in notions of evolution, homeostatic regulation,
and the organism.2 But the theoretical assumptions that have guided
cognitive science and neuroscience have made little use of these
evolutionary and organismic perspectives.
In recent years both neuroscience and cognitive science have

finally embraced emotions. There is a new generation of scientists
who are making emotion their field of study.3 Furthermore, the
supposed opposition between emotion and reason is no longer
accepted without question. For example, some of my lab work has
shown that emotion is integral to reasoning and decision-making
processes, for better and for worse.4 This may sound counterintuitive
at first, but there is evidence. who support it. The discoveries come
from the study of some individuals who were completely rational in
the way they managed their lives until, as a result of neurological
damage in areas
Specific to the brain, they lost certain types of emotions and as a

result of a transcendental parallelism they also lost the ability to make
rational decisions. Those individuals can continue to use the
instruments of their rationality and can still appeal to their knowledge
of the world around them. They continue to keep intact their ability to
pose the logic of any situation. And yet, many of their social and
personal decisions are irrational, generally adverse to themselves and
to others. My suggestion is that the delicate mechanism of reasoning
is no longer influenced, either unconsciously or sometimes consciously,
by signals from the neural machinery underlying emotions.
This hypothesis is called the somatic marker hypothesis and the

patients who led me to propose it had lesions in certain areas of the
prefrontal region, especially in the ventral and middle sectors and in
the right parietal region. Due to a stroke, a head injury, or a tumor
requiring surgical removal, damage to these regions was associated
in case after case with the appearance of that clinical pattern I
described earlier, that is, disturbance in the ability to to decide
advantageously in situations involving risk or conflict, as well as in the
selective reduction of the ability to enter into emotional resonance
precisely in those same situations while preserving all other emotional
capacities.
Prior to the onset of their brain damage, individuals thus affected had
not shown such disabilities. Family and friends could perceive a
"before" and an "after" from the date of the neurological damage.
These findings seem to indicate that selective reduction of

emotion is at least as detrimental as excessive emotion. It does not
seem to be true that reason gains anything if it works without the
counterweight of emotions. On the contrary, emotions probably help
reasoning, especially when it comes to personal and social matters
that involve
risks or conflicts. My suggestion was that a certain degree of emotion

processing indicates to us the sector of the decision-making space
in which our reason can function most effectively. What I have not
suggested, however, is that emotions are substitutes for reason or
that emotions decide for us. It is clear that emotional disturbances
can lead to irrational decisions. Neurological evidence simply seems
to indicate that the selective absence of an emotion is a problem.
Well-directed and well-deployed emotion seems to be a support
system without which the edifice of reason cannot function properly.
These results and their interpretation call into question the idea of
dismissing emotions as luxuries or annoyances or mere evolutionary
vestiges.
They have also made it possible to focus on emotions as embodiments

of the logic of survival.5
THE BRAIN KNOWS MORE THAN THE CONSCIOUS MIND REVEALS
Emotions, and sensations of emotions, respectively, are the

beginning and end of a progression, but the relative public display of
emotions and the complete privacy of corresponding sensations
indicate that the mechanisms along that continuum are quite different.
different. Making a distinction between emotions and sensations is
useful if we are to investigate those mechanisms in depth. I have
proposed reserving the term sensation for the private, mental
experience of an emotion, while the term emotion should be used to
designate the set of responses, many of which are publicly
observable. Which means in practical terms that we cannot observe
the sensation in another person although we can observe sensations
in ourselves when, as conscious beings, we perceive our own
emotional states. In the same way, no one can observe our
sensations, but some aspects of the emotions that give rise to our
sensations may be apparent to others.
And even more to my credit, the basic mechanisms underlying
emotion do not require awareness, even if they end up using it: we
can start the cascade of processes that lead to a display of emotion
without being aware of the inducer of the emotion, much less of it.
intermediate steps leading to it.
Indeed, it is even conceivable to produce a sensation in the limited
window of the here and now without the organism knowing that it is
actually happening. It is certain that at this point in evolution and at
this point in our adult lives, emotions occur in a constellation of
consciousness: we can coherently feel our emotions and we know
that we feel them.
The fabric of our mind and our behavior is woven through numerous
turns of emotions followed by sensations that become familiar to us
and that give rise to new emotions, a polyphony that underlines and
accentuates some specific thoughts of our mind and some actions of
our behaviour. But although emotions and sensations are now part of
a functional continuum, it is useful to distinguish the sections of that
continuum if we wish to study their biological bases with any success.
In addition, and as I have suggested before, it is possible that
sensations are located on the very threshold that separates being
from knowing and therefore have a privileged connection with
consciousness.6
Why am I so confident that the biological machinery underlying

emotions does not depend on consciousness?
After all, in our everyday experience, we tend to believe that we know
the circumstances that culminate in an emotion. But used to believe
that we know is not the same as always knowing. There is good
evidence for the covert nature of emotion induction, and I will illustrate
this point with some of the experimental results from my laboratory.
David, who has one of the most profound learning and memory
defects ever studied, cannot memorize any new facts. For example,
you cannot retain any new features, sounds, places, or words. As a
result, he cannot learn to recognize new people by face, voice, or
name, nor is he able to remember anything related to where he has
met a particular person or the events that have transpired between
that person. and the. David's problem is caused by extensive damage
to both temporal lobes, which involves damage to a region known as
the hippocampus (which must be intact to create memories of new
events) and the region known as the amygdala (a subcortical grouping
of nuclei related to emotion that I will mention in the following pages).
Many years ago I heard that David seemed to manifest, in his

daily life, some consistent likes and dislikes for certain people. For
example, in what has been his place of residence for most of the last
twenty years, there were specific people he frequently chose to go
with if he wanted to have a smoke or coffee, as well as specific people
he never went with. The consistency of these behaviors was all the
more intriguing considering that David could not recognize any of
these individuals at all, had no idea he had ever seen any of them,
and could not call any of them. by name or point to none of them if
their name was told. Could this intriguing story be more than just a
curious anecdote? I decided to check and examine it through an
empirical test. In order to do so, I collaborated with my colleague
Daniel Tranel to design an experiment that has come to be known in
our lab as the "good guy, bad guy" experiment . human under fully
controlled conditions. One was with someone tremendously nice and
welcoming and always rewarding David whether he ordered something

or not (he was the good guy). Another deal was with someone who
was emotionally neutral and involved David in activities that were
neither pleasant nor unpleasant (he was the neutral guy). The third
type of deal was with a gruff-mannered individual who told him "no"
whatever he asked for and subjected David to a very tedious
psychological task designed to bore holy Job (he was the bad guy).
The task was to discriminate the element different from the one shown
after a certain time, which was conceived at the time to investigate
the memory of monkeys and which is probably delicious as long as
you have the mind of a monkey.
The development of these different situations was organized
over five consecutive days, randomly, but always during a certain
time, in such a way that the exposure to the good, the bad and the
indifferent could be measured and compared appropriately. The very
complex development of this dance required different rooms and
several assistants who, by the way, were not the same as the good,
bad and neutral types.
After giving time for the various meetings to sink in, we asked
David to participate in two different tasks. In one, he was asked to
look at a set of four photographs, including the face of one of the
individuals in the experiment, while being asked: "Who would you go
to if you needed help?" and to make things even clearer: "Who do
you think is your friend in this group?"
David behaved spectacularly. When the individual who had been

positive towards him was part of the group of four, David chose him
80% of the time, indicating that his choice was not merely random...
mere chance would have resulted in David choosing him. I would
have chosen 25% of the time. The neutral individual was chosen no
greater percentage of the time than if it had been random. And he
almost never chose the bad guy, in a percentage that broke random
behavior again.
In a second task, David was asked to look at the faces of the

three individuals and tell us what he knew about them. As usual he
didn't say anything. David couldn't remember ever meeting them and
had no recollection of ever interacting with them. Needless to say, he
couldn't name any of those individuals, couldn't pinpoint them if we
gave him the name, and had no idea what we were talking about
when we asked him about the events of the previous week. But when
asked which of the three was his friend, he would pick the nice guy
over and over again.
The results show that the anecdote was worth investigating.

Certainly David had nothing in his conscious mind that offered him a
manifest reason for correctly choosing the good guy and correctly
rejecting the bad guy. He didn't know why he chose one or rejected
the other; I chose and that's it. However, the unconscious preference
that he manifested is probably related to the emotions that were
induced in him during the experiment, as well as the unconscious
reinduction of some of those emotions at the time of the questions.
David had not learned new things of the kind that can be unfolded in
the mind in the form of an image. But something remained in his brain
that could produce results, although not in the form of images, but in
the form of actions and behavior. David's brain could generate actions
proportionate to the emotional value of the original encounters,
caused by reward or lack thereof. To clarify this idea, let me describe
an observation I once made during the relationship sessions in the
good boy-bad boy experiment.
David was being taken to a session with the bad boy, and when
he turned down the hall and saw the bad boy waiting for him a few
steps away, he chickened out, paused for a moment, and only after
he had done so did he allow himself to be led gently into the room.
exam room. I noticed immediately and asked him what was going on,
if I could do something for him. But, as planned, I
he said no, that everything was in order... after all, nothing came to
his mind except, perhaps, an isolated feeling of an emotion without
any cause behind that emotion. I had no doubt that the sight of the
bad boy had induced a brief emotional response and a very brief
feeling right then and there. However, in the absence of an adequate
set of images to explain the cause of his reaction, the effect was
isolated, disconnected and therefore unmotivated.8
I also have little doubt that if, instead of carrying out this task in
one week, we had carried it out over successive weeks, David would
have mastered such negative and positive responses to engage in
the behavior that best suited his organism, that is, preferring
consistently the good guy and consistently reject the bad guy. But it
is not that I mean to suggest that he had deliberately chosen to do
so, but rather that his organism, with its design and dispositions,
would have directed such behavior. He would have developed a
tropism toward the good guy and a negative tropism toward the bad
guy, much as he had developed those same preferences in his real
life.
The situation I have just described allows us to argue other

things. First, that David's core consciousness is intact, a point we will
return to in the next chapter.
Second, just as in the context of the good boy bad boy experiment
David's emotions were unconsciously induced, in other contexts he
has emotions consciously. When you don't have to rely on a new
memory, you realize that you are happy because you are eating your
favorite food or seeing a pleasant scene. Third, given the remarkable
destruction of various emotion-related cortical and subcortical regions
of his brain, i.e., the ventromedial prefrontal cortices, the basal
forebrain, and the amygdala, it is clear that these regions are not
indispensable for either emotion or consciousness. We must also
keep in mind, for more
further, that certain structures of David's brain are still intact: the
entire brain stem, the hypothalamus and thalamus, most of the
cingulate cortices, and virtually all sensory and motor structures.
Let me close these comments by saying that the bad boy in our
experiment was a nice, pretty, young neuropsychologist. We had
thought of the experiment in this way so that she would go against
his character, since we wanted to determine to what extent David's
stated preference for the company of young and beautiful women
would counteract the contradictory nature of his behavior and the fact
that he was the transmitter of boring task.
(David has an eye for girls: I once caught him caressing Patricia
Churchland's arm while saying, "You're so soft...") Well, as you can
see, our well-intentioned approach to this wicked scheme gave way.
its fruits.
No natural beauty, no matter how great, could have made up for the
negative emotion induced by the bad boy's mannerisms and the lack
of entertainment provided by the task he set her.
We do not need to be aware of the inducer of an emotion and in
many cases we are not, nor can we control emotions at will. We can
be in a happy or sad state of mind, and yet we can be absolutely lost
as to why we are in such a state.
A careful search may uncover possible causes, and one or the other
may be more likely, but often we cannot be sure. The real cause may
have been the image of an event, an image that had the potential to
become conscious but was not because we did not pay attention to it
since we were on to something else. Or there may have been no
image at all, but rather a temporary change in the chemical profile in
our internal environment, caused by factors as diverse as our state of
health, diet, time, hormonal cycle, how much or how little we we have
moved that day or even how much we have been able to worry about
a certain matter. In that case,
the change would have been substantial enough to engender certain

responses and alter our bodily state, but it would not be transposable
into images in the same sense that an image of a person or a
relationship can be made, that is, it would not produce a sensory
pattern of which we could be mentally aware. In other words, there is
no need to be attentive to emotion-inducing representations that lead
to subsequent sensations, regardless of whether they mean something
external to the organism or something remembered internally.
Representations, both external and internal, can occur below the
recognition of consciousness and still continue to induce emotional
responses. Emotions can be unconsciously induced and thus appear
to the conscious being as apparently unmotivated.
We can partly control whether an image that aspires to be

inducing remains the target of our thoughts. (Those who have been
brought up Catholic know exactly what I mean, as do those who have
been trained in the ideas of the Actors Studio.) We may not succeed
in such a task, but the effort to set aside or maintain that inducer of
course occurs in consciousness. We can also have some control over
the expression of some emotions (suppressing our anger, masking
our sadness), but most of us are not very good at it, and that is a
good reason why we pay good money to see good actors. trained in
controlling their emotions (which is also why we can lose a lot of
money playing poker). However, once a concrete sensory
representation has been formed, whether or not it forms part of our
conscious flow of thought, we do not have much to say about the
mechanism of emotion induction. If the psychological and physiological
contexts are correct, an emotion will follow. The unconscious
triggering of emotions also explains why they are not easy to fake
voluntarily. As I explained in Descartes' Error, a spontaneous smile
that
whether it comes from genuine pleasure or spontaneous sobbing that

is caused by grief, they run on brain structures located deep in the
brainstem and under the control of the cingulate region. We have no
means of exercising direct voluntary control over the neural processes
in these regions. Willful imitations of expressions of emotion are easily
detected as false: there is always something wrong, be it in the facial
configuration of the facial muscles or in the tone of the voice.
The result of this state of affairs is that for most of us who are not
actors, emotions are a fairly acceptable index of how conducive the
environment is to our well-being, or at least how conducive our minds
like it. It seems.
We are just as easy to interrupt an emotion as we are to stop a
sneeze. We can try to prevent the expression of an emotion and we
can succeed in part, but not completely.
Some of us, under the appropriate cultural influence, can become
relative experts on the subject, but fundamentally what we achieve is
the ability to disguise some of the outward manifestations of emotion
without being able to block the automated changes that occur in the
emotions. viscera and in our internal environment. Remember the last
time you were moved in public and tried to hide it. It could have been
successful if it was a movie and if he was in a dark place, alone with
Gloria Swanson, but not if it was a eulogy for a deceased friend: his
voice would have given him away.
Someone once told me that the idea that sensations follow emotions
could not be correct since it is possible to suppress emotions and still
have sensations. But of course that's not true apart from the partial
suppression of facial expressions. We can educate our emotions but
not completely suppress them and the sensations that we harbor
inside us are the testimony of our failure.
A digression on the control of the uncontrollable
A partial exception to the extremely limited control we have over

our internal environment and our internal organs is that which refers
to respiratory control, on which we need to exert some voluntary
action, since autonomous breathing and voluntary vocalization to
speak and sing use the same instrument. We can learn to dive, to hold
our breath for longer and longer periods, but there are limits beyond
which not even an Olympic champion can survive.
Opera singers face a similar barrier: what tenor wouldn't want to hold
up chest C a little longer and thus irritate the soprano? But no matter
how much they train the larynx and diaphragm, neither tenor nor
soprano will be able to cross that barrier. Indirect control of blood
pressure and heart rate by procedures such as biofeedback are also
partial exceptions. However, as a rule, voluntary control over autonomic
function is modest.
However, I can account for one very striking exception.

A few years ago, the brilliant pianist Maria João Pires told us the
following story: When you play under the perfect control of your will,
you can increase or decrease the flow of emotion in your body. My
wife Hanna and I thought it was a wonderfully romantic idea but Maria
João insisted she was capable of it and we still don't believe her. We
ended up setting the stage in our laboratory for the moment of
empirical truth. We connected Maria João to the complicated
psychophysiological equipment while she listened to short musical
pieces of our choice in two situations: emotion allowed, emotion
voluntarily inhibited. His Chopin Nocturnes had recently been released
and as stimuli we used some of his and others played by Daniel
Barenboim. In the "emotion allowed" situation, the record of his skin
conductivity was full of ups and downs, mysteriously linked to the
various passages of the pieces. Then, in the "reduced emotion"

situation, the incredible indeed happened. He practically flattened the
graph of skin conductivity at will and altered his heart rate to boot. His
behavior also varied. The profile of their background emotions was
rearranged and some specific emotional behaviors disappeared: for
example, there was less facial and head mobility. When, in disbelief,
our colleague Antoine Bechara repeated the entire experiment,
thinking it might be a habit modality, she repeated the result. So, after
all, there are some exceptions that may be more prevalent precisely
in those whose job it is to create magic through emotion.
WHAT ARE EMOTIONS?
The mention of the word emotion usually brings to mind one of

the six so-called primary or universal emotions: happiness,
sadness, fear, anger, surprise or disgust. It simplifies the problem to
think about primary emotions, but it is important to realize that there
are numerous other behaviors that have been labeled "emotions."
They are the so-called secondary or social emotions , such as
embarrassment, jealousy, guilt or pride, or the so-called background
emotions, such as well-being or discomfort, calm or tension. The
label of emotion has also been applied to impulses and motivations
and to states of pain and pleasure.9 Underlying all these phenomena
lies a biological core
shared which can be outlined as follows:
1. Emotions are complex sets of chemical and neural responses

that form a pattern; all emotions have a certain kind of regulatory
role, leading in one way or another to the creation of advantageous
circumstances
for the organism that shows the phenomenon; Emotions refer to

the life of an organism, its body to be more precise, and its role
is to help the organism maintain life.
2. In addition to the reality that learning and culture alter the

expression of emotions and give new meaning to emotions,
emotions are biologically determined processes, dependent on
sets of innate brain devices provided by a long evolutionary
history.
3. Emotion-producing devices occupy a relatively restricted set of

subcortical regions, beginning in the brainstem and moving up to
the higher brain; Devices are part of a set of structures that
regulate and represent bodily states, which will be discussed in
Chapter 5.
4. All those devices can start up automatically, without conscious

deliberation; the enormous individual variety and the fact that
culture plays a role in the formation of some inducers do not
deny the stereotyped, automatic and regulating purpose of
emotions.
5. All emotions use the body as a stage (internal environment,

visceral, vestibular and musculoskeletal systems), but emotions
also affect the way many brain circuits work: the variety of
emotional responses is responsible for profound changes in both
the body landscape as in the brain landscape. The set of these
changes constitutes the substrate of the neural patterns that end
up becoming sensations of emotion.
At this point it is necessary to say something about the underlying emotions

because the label and the concept are not part of the traditional debates about
emotions. When we notice that a person is "tense" or "nervous", "discouraged" or
"excited", "down" or "up" without a word being said that reveals any of these possible
states, we are detecting background emotions. We detect these background emotions
through subtle details of body postures, speed and dexterity of movements, minute
changes in gaze and eye speed, and the degree of contraction of facial muscles.
The inducers of background emotions are usually internal.

The processes of regulating life themselves can give rise to background emotions, but
the same can happen with continuous processes of mental conflict, overt or covert,
since they lead to a sustained satisfaction or inhibition of drives and motivations. For
exam- it is hard to take (one of the hidden reasons behind Prince Hamlet's despondent
existence) or to savor the prospects of some wonderful pleasure that may await us. In
short, certain conditions of the internal state generated by biological processes in
progress or by the relationship of the organism with its environment or both, originate
responses that constitute background emotions. These emotions allow us to feel,
among other things, the background sensations of tension or relaxation, fatigue or
energy, well-being or discomfort, joyous anxiety or fear.10
In background emotions, the constitutive responses are closer to the inner core
of life and their target is more internal than external. In background emotions, the
profiles of the internal environment and of the viscera play a major role. But
Although background emotions do not use the distinct repertoire of

explicit facial expressions that define primary and social emotions,
they are also complexly expressed through musculoskeletal changes,
for example, in subtle body postures and in the general appearance
of all body movement. .eleven
In my experience, background emotions are brave survivors of
neurological disease. For example, they are preserved in patients
with ventromedial frontal damage, as well as in those with damaged
amygdala. It is somewhat mysterious, as will be seen in the next
chapter, that background emotions are affected when the basic level
of consciousness, the central consciousness, is also affected.
THE BIOLOGICAL FUNCTION OF EMOTIONS
Although the exact composition and dynamics of emotional

responses are shaped in each individual through a unique development
and environment, the evidence seems to indicate that most, if not all,
emotional responses are the result of a long history. of evolutionary
refinement. Emotions are part of the regulatory devices with which
we are equipped to survive. This is why Darwin was able to catalog
the emotional expressions of so many species and discover a
coherence in such expressions and why emotions are so easily
recognized in different parts of the world. Surely there are variable
expressions and there are variations in the exact configuration of the
stimuli that can induce emotion in different cultures and between
different individuals. But what one marvels at, flying all over the planet,
is the similarity and not the difference. By the way, that similarity is
what makes intercultural relations possible and
that allows art and literature, music and movies to cross borders.
This idea has received immeasurable support through the work of
Paul Elkman.12
The biological function of emotions is twofold. The first function
is the production of a specific reaction to the inducing situation. In an
animal, for example, the reaction may be to run away or freeze or
engage the enemy or engage in pleasurable behavior. In humans,
the reactions are basically the same, presumably tempered by
greater wisdom and reason. The second biological function of
emotion is the regulation of the internal state of the organism in such
a way that it can be prepared for that specific reaction. For example,
by providing increased blood flow to the arteries in the legs so that
the muscles receive extra oxygen and glucose, in the event of a
running reaction, or a change in heart and breathing rates in the
event of standing still . In any case, and in other situations, the plan
is exquisite and the execution is extremely reliable. In short: for
certain classes of clearly dangerous or clearly valuable stimuli, in the
internal or external environment, evolution has composed an
appropriate response in the form of emotion. That is why, despite the
infinite number of variations found across cultures, across individuals,
and over the course of a lifetime, we can predict with any success
that certain stimuli will produce certain emotions. (That's why we can
say to a colleague, "Go tell her; she'll like to hear it.")
In other words, the biological "purpose" of emotions is clear, and

emotions are not an expendable luxury. Emotions are curious
adaptations that form art and part of the machinery with which
organisms regulate their survival. As old as they are in the
evolutionary aspect, emotions are a fairly high-level component in
the mechanisms of regulation of life. We can imagine this component
sandwiched
between the survival package (for example, regulation of metabolism,

simple reflexes, motivations, biology of pain and pleasure) and the
artifices of higher reason, but still forming a large part of the hierarchy
of vital regulation devices . For less complicated species than
humans, as well as for distracted humans, emotions actually produce
quite reasonable behavior from the point of view of survival.
Table 2.1. Vital regulation levels
The elementary level of life regulation (the survival package) includes biological states
that can be consciously perceived as drives and motivations and as states of pain and
pleasure. Emotions are on a higher level
tall and complex. Arrows in two directions indicate causation up or down. For example,
pain can induce emotions, and some emotions can encompass a state of pain.
At their most basic, emotions are part of homeostatic regulation

and are arranged to prevent the loss of integrity that is the harbinger
of death or death itself, as well as to vouch for a source of energy, a
refuge, or a source of energy. sex. And as a result of powerful learning
mechanisms such as conditioning, emotions of all kinds end up
connecting homeostatic regulation and survival "values" to numerous
events and objects in our autobiographical experience. Emotions are
inseparable from the idea of reward or punishment, of pleasure or
pain, of approach or abandonment, of personal advantages or
disadvantages.
It is inevitable that emotions are inseparable from the idea of good

and evil.
We might have wondered about the importance of discussing the
biological role of emotions in a text devoted to the subject of
consciousness. Its relevance should now be clear.
Emotions automatically provide organisms with behaviors aimed at
survival. In organisms prepared to feel emotions, that is, to have
sensations, emotions also influence the mind, here and now, as they
occur. But in organisms equipped with consciousness, that is, in those
organisms capable of knowing their sensations, another degree of
regulation is achieved. Awareness allows sensations to be known and
thereby promotes the internal impact of emotion and allows emotions
to permeate the thought process using sensations. Later,
consciousness allows knowledge of any object (the emotion "object"
or any other) and thereby enhances the organism's ability to respond
adaptively, attentively to
the needs of the organization in question. Emotion is dedicated to the

survival of the organism, just like consciousness.
INDUCTION OF EMOTIONS
Emotions occur in two types of circumstances. The first occurs

when the organism processes certain objects and situations with one
of its sensory devices, for example when the organism captures the
image of a familiar face or place. The second type of circumstance
occurs when the mind of an organism retrieves certain objects and
situations from its memory and represents them as images of the
thought process, for example by remembering the face of a friend or
the fact that that friend has died a long time ago. little bit.
An obvious fact when we consider emotions is that certain types

of objects or events tend to be systematically linked more to certain
kinds of emotion than to others. The types of stimuli that cause
happiness or fear or sadness tend to cause them quite frequently in
the same individual or in individuals who share the same social and
cultural background. Despite all possible individual variations in the
expression of an emotion, and despite the fact that we may have
mixed emotions, there is a rough correspondence between the types
of emotion inducers and the resulting emotional state. Throughout
evolution, organisms have acquired the means to respond to certain
stimuli (especially those that are potentially useful or potentially
dangerous from the point of view of survival) with the collection of
responses that we usually call an emotion.
But here you need to take precautions. I mean exactly what I

mean when I speak of ranges of stimuli that are inducers of particular
classes of emotion. Left
much room for very wide variations in the type of stimuli that can
induce emotions (both in individuals and in cultures) and I draw
attention to the fact that, regardless of the degree of biological
presetting of the emotional machinery, development and culture have
much to do with it. say about the final product. In all likelihood,
development and culture superimpose the following influences on pre-
existing devices: first, they shape what constitutes the proper inducer
of a given emotion; second, they shape some aspects of the
expression of emotion, and third, they shape the knowledge and
behavior that follow the display of an emotion.13
It is also important to realize that just as the biological machinery

of emotions is largely hardwired, inducers are not part of that
machinery, they are external to it. The stimuli that cause emotions
are by no means restricted to those that have helped shape our
emotional brain during evolution and that can induce emotions in our
brains very early in life. As they develop and interact, organisms gain
factual and emotional experience in relation to different objects and
situations in their environment and thus have the opportunity to
associate many objects and situations that would have been
emotionally neutral with the objects and situations that are naturally
prescribed to cause emotions. The form of learning known as
conditioning is one way to obtain this association. A house similar to
the one in which you spent a happy childhood may make you feel
good, even though nothing particularly pleasant has happened to you
in this second home yet. In the same way, the face of a wonderful
and unknown person that reminds us of someone associated with a
certain unfortunate event can cause us discomfort or irritation. We
may never even know why. It was not Nature that prescribed such
answers but surely contributed to our acquisition.

Incidentally, this is how superstitions appear. In the distribution of
emotions in our world there is something Orwellian: all objects can
acquire some emotional attachment, but some acquire greater
attachment than others.
Our basic biological design biases our secondary acquisitions in
relation to the world around us.
The consequence of extending emotional value to objects that
were not biologically prescribed to be emotionally charged is that the
range of stimuli that can induce emotions is potentially infinite. Without
knowing how, most objects and situations lead to a certain emotional
reaction, although some go further than others. The emotional reaction
can be weak or strong (and fortunately for us it is weak in most cases)
but it is still there. Emotion and the biological machinery that underlies
it are the obligatory companions of behavior, conscious or unconscious.
Thinking about oneself or one's environment has a certain degree of
emotionality as its obligatory companion.
The omnipresence of emotion in our development and,

consequently, in our daily experience, connects practically every
object or every situation of our experience, thanks to conditioning,
with the fundamental values of homeostatic regulation: reward and
punishment, pleasure and pain, approximation or abandonment,
personal advantage or disadvantage and, inevitably, good (in the
sense of survival) or bad (in the sense of death). Whether we like it or
not, this is the natural human condition. But when awareness is
available, sensations have maximum influence and individuals are
also able to reflect and plan. They have a means of controlling the
omnipotent tyranny of emotion: what we call reason. By
Of course, it is ironic that the motors of reason still need emotion,

which means that the controlling power of reason is usually rather
modest.
Another important consequence of the omnipotence of the
emotions is that practically every image, whether perceived or
remembered, is accompanied by a certain reaction of the emotion
apparatus. We will bear in mind the importance of this fact when we
discuss the mechanisms of the birth of consciousness in Chapter 6.
Let me close this discussion of emotion inducers with a reminder

of a tricky aspect of the inducement process. So far I have referred to
the direct inducers: thunder, snakes, happy memories. But emotions
can be induced indirectly, and the inducer may produce its result in a
somewhat negative way, by blocking the progress of an ongoing
emotion. Here's an example. When, in the presence of a food source
or sex, an animal develops approach behavior and shows traits of the
happiness emotion, blocking it from achieving its goals will cause
frustration and even anger, an emotion very different from happiness.
The inducer of anger is not the prospect of food or sex but rather the
interruption of the behavior that was leading the animal toward that
good prospect. Another example would be the sudden suspension of
a punishing situation (for example, sustained pain), which would
induce well-being and happiness. The purifying (cathartic) effect that
all good tragedies should have, according to Aristotle, is based on the
sudden suspension of a strongly induced state of fear and pity. Many
centuries after Aristotle, Alfred Hitchcock developed a brilliant
profession based on this simple biological scheme and Hollywood has
never failed to take it into account. Whether we like it or not, we're
very comforted when Janet Leigh stops screaming in the shower and
lies on the bottom of the tub.* As far as I know
When it comes to emotion, there are not many possible escapes from
the disposition with which nature has endowed us. We take it and it
takes us.
The mechanics of emotion
From experience, we know that the responses that constitute

emotions are highly varied. Some answers come easily in all of us.
Think of the muscles of the face that take on the typical forms of joy
or sorrow or anger; or in the skin that whitens as a reaction to bad
news or that reddens in a situation of embarrassment; or in body
postures that indicate joy, defiance, sadness or despondency; in the
wet and sticky palms of apprehension; or in the accelerated heart that
is associated with pride; or in the slowing down, in the almost
immobility of the heart in the face of terror.
Other answers are not in sight but are no less important for that,
such as the myriad of changes that occur in organs other than the
blood vessels, the skin, or the heart. An example is the secretion of
hormones, such as cortisone, which alter the chemical profile of the
internal environment; or the secretion of peptides, such as b-endorphin
or oxytocin, which alter the functioning of certain brain circuits.
Another is the release of neurotransmitters, such as monoamines,
norepinephrine, serotonin, and dopamine. During emotions, neurons
located in the hypothalamus, basal forebrain, and brainstem release
these chemicals in various higher brain regions, and in doing so
temporarily change the way many neural circuits operate. The
characteristic consequences of increasing or decreasing such
transmitters include the sensation we have of mental processes
speeding up or slowing down, not to mention the
Pleasant or unpleasant sensation that pervades mental experience.

These sensations are part of our feeling emotions.
Different emotions are produced by different brain systems. In

the same way that we can tell the difference between a facial
expression of anger and one of joy, in the same way that we can tell
the difference between sadness and happiness in our flesh,
neuroscience is beginning to show us how different brain systems
work to produce, for example, anger, sadness or happiness.
The study of patients with neurological diseases and localized

brain damage has provided some of the most revealing results in the
field, but these investigations are now being complemented by
functional neuroimaging of individuals who do not have neurological
diseases. I would like to point out that working with humans also
allows for an enriching dialogue with researchers dealing with these
same problems in animals, another welcome development in this field
of research.
The essence of the available discoveries can be summarized as

follows. First, the brain induces emotions from a remarkably small
number of brain locations. Most of them are located under the cerebral
cortex and are known as subcortical. The main subcortical sites are
in the region of the brainstem, the hypothalamus, and the basal
forebrain. One example is the region known as the periaqueductal
gray (PAG) which is a major region in coordinating emotional
responses. PAG acts via the motor nuclei of the reticular formation
and via the nuclei of cranial nerves, such as the nuclei of the vagus
nerve.14 Another important subcortical site is the amygdala. The
inducing sites of the cerebral cortex, the cortical sites, encompass
sectors of the anterior cingulate region and the midventral prefrontal
region.
Second, these places are involved in processing different

emotions to different degrees. We have recently shown, using PET
images, that the induction and experience of sadness, anger, fear,
and happiness lead to activation of some of these sites, but that the
pattern of each emotion is characteristic.
For example, sadness regularly activates the midventral prefrontal

cortex, the hypothalamus, and the brainstem, whereas anger and
fear activate neither the prefrontal cortex nor the hypothalamus. All
three emotions share brainstem activation, but intense hypothalamic
and midcentral prefrontal activation appears specific to sadness.15
Third, some of these locations are also involved in recognizing stimuli
that signify certain emotions. For example, a certain series of
studies in my laboratory have shown that the structure known as the
amygdala, which lies deep in each temporal lobe, is essential for
recognizing fear in facial expressions, for being conditioned to fear,
and for fear. even to express fear. (In a parallel series of papers,
studies by Joseph LeDoux and Michael Davis have shown that the
amygdala is necessary for fear conditioning and have revealed details
of the circuitry involved in this process.)16 However, the amygdala is
of little interest . in the recognition or learning of disappointments or
happiness. The important thing is that there are other equally specific
structures that are interested in other emotions and not precisely in
fear.
Figure 2.1. The main locations of induction of emotions. Only one of the four is
visible on the brain surface (the middle ventral prefrontal region). The other
regions are subcortical (see figure A.3 in the appendix for their exact location). All
of them are located near the midline of the brain.
The following description illustrates the fine print of brain systems

related to emotion production and recognition. It is just one of several
examples that could be adduced to support the idea that there is not a
single brain center for processing emotions, but rather discrete systems
related to separate emotional patterns.
do not fear
Almost a decade ago, a young woman, whom I will call S, caught my

attention because of the appearance of the CT scan of her brain.
Unexpectedly, his scan revealed that he had both tonsils, the one in the
right temporal lobe and the one in the left temporal lobe, almost completely
calcified. The appearance is shocking. On a CT scan, a normal brain
shows a myriad of gray pixels, with the intensity of the gray defining the
outline of structures. But if a mineral such as calcium is deposited

within the brain matter, the scan shows it as a bright milky white that
is unmistakable.
Around the two tonsils, the brain of patient S was perfectly
normal. But the amount of calcium deposition was such that it was
immediately apparent that only little or no neuron function could occur
within the tonsils. Each of the amygdala is a kind of crossroads, in
which many pathways from cortical and subcortical regions terminate
and many others that leave it in the direction of those regions. The
normal functions that take place at such a profuse crossroads simply
could not occur on either side of S's brain. Nor was it a recent affliction
of his brain. The deposit of minerals in the brain tissues takes a long
time and that specific and exhaustive work that we saw in his brain
had surely taken many years, having to have started in the first years
of his life.
For those who may be curious about the causes of this problem, I will
say that S has Urbach-Wiethe disease, a very rare autosomal
recessive condition characterized by abnormal calcium deposits in
the skin and throat. When the brain is affected by calcium deposits,
the structures that are most often affected are the tonsils. These
patients often have seizures, fortunately not severe, and it was
certainly a minor seizure that first brought S into our hands. We were
able to help her and since then she has had no more seizures.
My first impression of S was that of a tall, slim, extremely pleasant

young woman. I was very curious especially to find out about their
learning and memory abilities, as well as about their social behaviour.
My reason for this curiosity was twofold. At that time there was much
controversy about the role of the amygdala in learning new facts, and
some researchers believed that the amygdala was an essential
companion.
of the hippocampus in the acquisition of new memories of events,

while others thought that in this regard it had little to contribute. My
curiosity about its behavior was based on the fact that from studies
with non-human primates it was known that the amygdala has a role
in social behaviors.17
Figure 2.2. Bilateral tonsil lesion in patient S (left panel) and normal tonsil (right
panel). Sections were obtained according to the two perpendicular planes
indicated by two white lines on the external surface of the brain. The black areas
indicated by arrows are the injured tonsils. Compare with normal tonsils from
a control brain in those same sections in the two figures on the right.
I can sum up the story by saying that S had nothing at all wrong
with his ability to learn new facts.
Which was evident when I saw her a second time and she clearly
recognized me, smiled at me and greeted me by name. His quick
learning of who I was, what my face looked like, and what he called
me was flawless. Numerous psychological tests corroborated this first
impression and this is how things continue today. Years later we would
show that there was a defective aspect in relation to their learning, but
not with the learning of the facts but with the conditioning before
unpleasant stimuli.18
His social history, on the other hand, was exceptional. To put it

most simply, I would say that S approached people and approached
situations with a predominantly positive attitude. Some will say that
his approach was excessively and inappropriately open. S was not
only pleasant and spirited, but seemed eager to engage with anyone
who struck up a conversation with her, and people on the clinical and
research teams felt that she simply lacked the reserve and reticence
that might be expected of her. For example, shortly after being
introduced, S was not shy about hugging and touching. Be careful,
let's not get confused, his behavior did not make anyone feel
uncomfortable but was simply perceived as very far from the standard
behavior of a patient in his circumstances.
We would end up finding out that this same attitude permeated

all areas of his life. She made friends easily, mated easily, and had
often been taken advantage of by those she trusted. On the other
hand, she was and is a very responsible mother and goes to great
lengths to abide by social rules and to be valued for those efforts. Of
course it is difficult to describe human nature and in the best of
circumstances and in the best of health it is full of contradictions. It is
almost impossible to do it justice when we enter the realm of disease.
The first years of research with S yielded two important results.

For one thing, S had no problem memorizing facts. Indeed, it was
possible to say that his sensory perceptions, his movements, his
language, and his basic intelligence were no different from those of
the average completely healthy individual as far as elementary
faculties were concerned.
On the other hand, his social behavior showed the persistent bias of
his predominant emotional tone. It was as if negative emotions, such
as fear and anger, had been removed from his affective vocabulary,
allowing positive emotions to dominate his life.
at least with greater frequency if not with greater intensity. This was
of particular interest to me because I had seen a similar pattern in
patients with bilateral damage to the anterior temporal lobe, who, as
part of their extensive lesions, also had damage to the tonsils. It was
reasonable to hypothesize that his affective bias had to do with
damage to the amygdala.
All of these assumptions became incontestable facts when Ralph

Adolphs joined my lab. Through a variety of skillful research
techniques on a variety of patients, some with damage to the
amygdala and others with damage to other structures, Adolphs was
able to determine that the affective bias was largely caused by
impaired emotion: fear.19 Using a multidimensional adjustment
technique, Adolphs showed that S could not consistently detect the
expression of fear on another person's face, particularly if the
expressions were ambiguous or when other emotions were expressed
simultaneously. He had no such problem recognizing other facial
expressions of emotion, for example surprise, which in many ways
has a similar general configuration.
Interestingly, S, who has remarkable drawing skills and good

technique, cannot draw a face that represents fear, although he can
draw other faces that represent other emotions. When asked to
imitate emotional facial expressions, he does so easily for primary
emotions but not for fear. His attempts produce minimal changes in
his facial expression, after which he confesses his complete failure.
In this case, he also has no difficulty putting on a surprised facial
expression. Finally, S does not experience fear in the same way that
you or I do in a situation that should normally induce it. In a purely
intellectual way he knows what fear is supposed to be, what can
cause it and even what can be done in situations of fear but, so to
speak, little or
none of such intellectual baggage serves him in the real world. His
non-intimidating nature, the result of bilateral amygdala damage, has
prevented him from learning throughout his short life the meaning of
unpleasant situations that all of us have been through. The result is
that you have not learned to identify the telltale signs that herald
potential danger and potential discomfort, especially when they
appear on other people's faces or occur in a situation. This has never
been more clearly demonstrated than in a recent study calling for a
judgment of honesty and approachability based on human faces.20
This experiment called for a judgment of a hundred human faces
previously rated by normal individuals as indicative of varying
degrees of honesty and approachability. There were fifty faces that
had always been judged to be inspiring confidence and another fifty
that had not. The selection of the faces had been made by normal
individuals who had been asked a simple question: on a scale of one
to five, how would you rate the individual's honesty and approachability
as inspired by their face? Or, in other words, if you needed help, how
compelled would you be to ask a guy with this face?
Having distributed the hundred faces based on the classifications

of the forty-six normal individuals, we move on to the brain-injured
patients. S was one of three patients with bilateral amygdala damage
included in the study, but we also investigated the outcomes of seven
patients with lesions to either the left or right amygdala, three patients
with hippocampal damage and an inability to learn new facts and
from ten patients with lesions in other parts of the brain, that is,
outside the amygdala and hippocampus. The results were more
remarkable than expected.
S, along with the other patients who had lesions in the tonsils on
both sides of the brain, looked at the faces that you and I would
consider trustworthy and classified them,
virtually without error, just as you or I would have done, as faces you
could reach out to if you needed help.
But when they looked at faces you and I would be wary of, people
we'd try to avoid, they judged them equally trustworthy. The patients
with only one damaged amygdala, the amnesic patients, and the other
patients with other brain damage had results equal to those of normal
individuals.
The inability to make adequate social judgments, based on

previous experiences, of situations that may or may not be conducive
to personal well-being has important consequences for those affected
in this way.
Immersed in a secure Polyyannesque world,* these individuals cannot
protect themselves against simple and not-so-simple social risks and
are therefore more vulnerable and less independent than we are.
Their lives testify to this chronic deterioration just as they testify to the
paramount importance of emotion in governing not only simple
creatures but also humans.
How the set works
Thus, in a characteristic emotion, certain brain regions, which

are part of a largely pre-organized emotion-related system, send
commands to other brain regions and to most host parts of the body.
Orders are shipped via two different routes. One is the bloodstream,
through which the orders travel in the form of chemical molecules that
act on the receptors of the cells that make up the body's tissues.
The other consists of neuronal pathways, and the orders that travel
through it do so in the form of electrochemical signals that act
on other neurons, on muscle fibers, or on organs (such as the adrenal

glands) that in turn release their own chemicals into the bloodstream.
The result of these coordinated chemical and neural commands

is an overall change in the state of the organism. The organs that
receive the commands change as they are commanded, and the
muscles, whether the smooth muscles of the blood vessels or the
striated muscles of the face, move as commanded. But just as
remarkable is the change in the brain. The release of substances
such as monoamines and peptides from nuclei in the brainstem and
basal forebrain regions alter the processing of numerous other brain
circuits, trigger specific behaviors (eg, mating, playing, crying), and
modify signaling of bodily states to the brain. In other words, both
brain and body are affected widely and deeply by the set of commands,
even though the origin of these commands is confined to a relatively
small area of the brain that responds to a specific content of the
mental process. Next consider the following: Beyond the emotion,
specifically described as the collection of responses I just outlined,
two more steps must be taken before an emotion is known . The first
is the sensation, the image of the changes that we have just seen.
The second is the application of the central consciousness to the
entire set of phenomena. Only at that moment is the knowing of an
emotion, the feeling of a sensation.
These events can be summarized by going through the three key

steps of the process:
1. The triggering of the organism by an inducer of emotion, eg, a

visually processed concrete object, resulting in visual
representations of the object.
Imagine running into Aunt Marga, whom you love and whom you
haven't seen for a long time. Most likely you
recognize Aunt Marga immediately, but even if you don't

recognize her, or even before you can recognize her, the basic
process of the emotion keeps going until the second step.
2. The signals subsequent to the processing of the image of the
object activate the neural locations that are prepared to respond
to the specific type of inducer to which the object belongs. The
locations I refer to (for example, in the ventromedial prefrontal
cortices, the amygdala, and the brain stem) are innately arranged,
but past experiences with Marga have modulated their response:
for example, in ease with they can answer. Incidentally, Aunt
Marga doesn't travel around the brain in the form of a passport
photo. It exists as a virtual image, arising from neural patterns
generated by the relationship of various areas of the visual
cortex, especially in the occipital lobes. The signals following the
presence of her image travel everywhere and do their job when
those parts of the brain that are interested in things related to
Marga respond.
3. As a consequence of step 2, the sites of emotion induction trigger

a number of signals to other parts of the brain (for example, to
the monoamine nuclei, somatosensory cortices, and cingulate
cortices) and to the body ( for example, to the viscera and the
endocrine glands), as already indicated above. Under certain
circumstances, the balance of responses can favor intracerebral
circuits and instead mobilize the body minimally. These are what
I have called "body-loop" responses.
The combined result of steps 1, 2 and 3 is an appropriate and

momentary collection of responses to the circumstances causing the
shock: for example, spotting Aunt Marga; or the announcement of the
death of a friend, or anything that we can define
consciously, or if we are a little bird in a nest the image of an object

that flies over us. Let's take this last example. The little bird has no
idea that it is a predatory eagle and has no conscious sense of the
danger that awaits it. In the strict sense of the term, there is no
thought process that tells the little bird what to do next, which is to
snuggle as close as possible in the nest and stay as quiet as possible
to see if the eagle will miss it. And yet, the steps of the process that I
have just described have been taken: visual images have been
formed in the little bird's visual brain, some sectors of its brain have
responded to the type of visual image that the brain has formed, and
put into full swing the appropriate chemical and neural, autonomic,
and motor responses. The calm and constant pace of evolution has
thought of everything in the place of the little bird and its genetic
system has duly transmitted it to it. With a little help from his mother
and with some previous circumstances, the mini-concert of fear is
ready to be performed when the situation demands it. The fear
response that we can see in a dog or a cat is executed in the same
way, and that is the same response that we can detect in ourselves
when walking down a dark street at night. That we, thanks to the
conscience, or the dog and the cat in the last extreme, also come to
know those sensations caused by those emotions, is another matter.
The truth is that we can find the basic configuration of emotions

in simple organisms, and even in unicellular organisms, and we
would end up attributing emotions such as happiness, fear or anger
to very simple creatures that, with absolute probability, do not feel
such emotions in the sense in which they are felt by you or me,
creatures that are either too simple to have a brain or, if they do, too
rudimentary to harbor a mind. We make these attributions purely on
the basis of the movements of the organism, the speed of each of its
acts, the number of actions per unit of
time, the style of their movements and so on.

We can do the same thing with a simple cursor moving on a computer
screen. Some of his sudden jerky movements will seem "angry", the
harmonious but sudden jumps will seem "joyful" and if he recoils he
will seem "scared". A video that represents various geometric shapes
that move with different speeds and that maintain different relationships
surely provokes attributions of emotional states in normal adults and
also in children. The reason why we can so effectively
anthropomorphize the cursor or the animal is quite simple: emotion,
as the word indicates, refers to movement, to externalized behavior,
to the orchestration of reactions to a given cause within a given
environment. .twenty-one
Halfway between a cursor and a domestic animal is one of the

living creatures that has contributed most to the progress of
neurobiology, a marine snail known as Aplysia californica. Eric
Kandel and his colleagues have made great inroads into the study of
memory using this very simple snail, which may not have much of a
head but does have a scientifically decipherable nervous system and
many interesting behaviors. Well, Aplysia may not have sensations
like you or me, but she has something that is not very different from
emotions. Touch an Aplysia 's fin and you'll see it curl up completely
and quickly, while Aplysia 's heart rate increases and she releases
ink around her surroundings to confuse the enemy, a bit James Bond-
like when Dr. No. Aplysia gets excited about a mini-concert of
responses that is not formally different, just simpler, from the one you
or I would perform under equivalent circumstances. Since Aplysia
can represent her emotional state in the nervous system, she may
have the
rudiments of sensations. We don't know if Aplysia has them or not,

but it is extremely difficult to imagine that Aplysia knows about such
sensations if she does.22
REFINED OF THE DEFINITION OF EMOTION: A DIGRESSION
Who is a candidate to be emotion? The pain? A startle reflex?

None; but if none is, why? The proximity of these related phenomena
demands very fine distinctions but we tend to overlook the differences.
Startle reflexes are part of the repertoire of regulatory responses
available to complex organisms and are shaped by simple behaviors
(eg, hiding limbs).
They may be included among the many concerted responses that

constitute an emotion: endocrine responses, multiple visceral
responses, multiple musculoskeletal responses, and so on. But even
Aplysia 's simple emotional behavior is more complicated than a
simple startle reflex.
Neither is pain a candidate. Pain is the consequence of a state
of localized dysfunction in living tissue, the consequence of a stimulus
(present or imminent injury to the tissue) that causes the sensation of
pain but also causes regulatory responses like reflexes and can also
induce other emotions on your own. In other words, emotions can be
caused by the same stimulus that causes pain, but they are different
results of the same cause. Consequently, we can come to know that
we feel pain and that we feel an emotion associated with pain as long
as there is awareness.
When you picked up that hot plate the other day and burned your
fingertips, you felt pain and might even suffer from it.
In the simplest neurobiological terms this is what happened to you:
First, the heat activated a large number of very thin, unmyelinated

nerve fibers, called C-fibers, near the burn. (These fibers, which are
literally distributed throughout the body, are evolutionarily ancient and
are primarily dedicated to carrying signals from the body's internal
states, including those that end up causing pain. They are called
unmyelinated because they lack the insulating sheath called myelin:
Lightly myelinated fibers called A-ÿ lie along the C fibers and perform
a similar task.
Both are called nociceptive because they respond to stimuli that are,
or may be, harmful to living tissue.)
Second, the heat destroyed a few thousand skin cells, and that
destruction released a number of chemicals in that area.
Third, various kinds of white blood cells involved in rebuilding

damaged tissue were summoned to the area: that summoning was
made by some of those released chemicals (for example, a peptide
substance called substance P and certain ions, such as potassium ).
Fourth, several of these chemicals activated nerve fibers on their

own, joining their voices to those of the heat itself.
Once the wave of activation began in the nerve fibers, it traveled

down the spinal cord and a chain of signals was produced passing
through different neurons (a neuron is a nerve cell) and different
synapses (a synapse is the point where two neurons connect and
signals are transmitted) along the proper pathways. The signals
traveled all the way up to the higher levels of the nervous system: the
brain stem, the thalamus, and even the cerebral cortex.
And what happened as a result of this succession of signals?

That groups of neurons located at different levels of the nervous
system were temporarily activated and that this activation produced a
neural pattern, a kind of map of the signals
related to finger damage. The central nervous system already had

varied and multiple neural patterns of tissue damage according to the
biological specifications of its nervous system and the body to which
it is connected. The necessary conditions were already present to
cause a sensation of pain.
The question I am aiming at arises at this point: would one of
these neural patterns of tissue damage (or all of them together) be
the same as knowing that you feel pain? And the answer is, truly,
no. Knowing that pain is felt requires something more that occurs
after the neural patterns that correspond to the pain substrate (the
nociceptive signals) appear in the appropriate areas of the brain stem,
thalamus and cerebral cortex and generate an image of pain. pain, a
feeling of pain. But keep in mind that the "later" process I am referring
to is not beyond the brain but fundamentally in it and, to my
impression, is just as biophysical as the process that occurred
immediately before it. Specifically, in the example above, it is a
process that interrelates the neural patterns of tissue damage with
the neural patterns that are you in such a way that yet another neural
pattern can emerge: the neural pattern of you as knowing what you
are. occurs, which is another name for consciousness. If that last
process that produces the interrelation does not take place, you will
never know that your organism has suffered damage in any of its
tissues: if there is no you and there is no knowledge, there is no way
for you to know, right? is that so?
The curious thing is that, if there had been no you, that is, if you
had not been aware and there had been no being and no knowledge
about hot dishes and burnt yolks, the rich machinery of your "without-
being" brain would have used the patterns just as well. nociceptive
neural pathways caused by tissue damage to produce a number of
useful responses. For example, the body would have been able to
remove the arm and hand from the heat source in a matter of tenths
of a second.
after tissue damage begins, a reflex process mediated by the central

nervous system. But notice that in the previous sentence I said
"organism" and not "you". Without knowledge and without being, it
would not have been "you" who withdrew the arm. In those
circumstances, the reflection would belong to the organism but not
necessarily to "you." What's more, a number of emotional responses
would be set in motion automatically, producing changes in facial
expression and posture, as well as changes in heart rate and blood
circulation control: not that we learn to grimace from pain, is that we
wince. Although all of these simple and not-so-simple responses
undoubtedly occur in comparable situations in all conscious human
beings, consciousness is not required at all for the responses to
occur. For example, many of these responses are present even in
comatose patients in whom consciousness is suspended: one of the
ways neurologists assess the state of the nervous system in an
unconscious patient is to see if the patient reacts with movement.
face and extremities to unpleasant stimuli such as rubbing the skin
that covers the sternum.
Tissue damage causes neural patterns whenever your body is in

a state of pain. If you are conscious, these same patterns can let you
know that you are in pain. But whether you are aware of it or not, the
tissue damage and subsequent sensory cues also cause the variety
of automated responses we have seen before, from simple limb
withdrawal to complex negative emotion. In short, pain and emotion
are not the same thing.
We may wonder how we can make such a distinction, and I can

adduce a large body of evidence to support it.
I will start with a fact that comes from the direct experience of a
patient, at the beginning of my training, in which dissociation
between pain itself and emotion caused by pain was vividly

apparent.23 The patient suffered from an acute case of refractory
trigeminal neuralgia, also known as tic doulus. This is a disease of
the nerve that provides sensation signals to the face, in which even
a mild stimulus, such as a light touch to the face or a sudden breeze,
triggers a lancinating pain. There was no medication to help the
young man, who could do nothing but curl up, motionless, as the
searing pain tore through his flesh. As a last resort, the neurosurgeon
Almeida Lima, who in turn was one of my first mentors, offered to
operate on him because it had been observed that causing small
lesions in a specific sector of the frontal lobe relieved pain and the
technique was used last. extreme in diseases like this.
I will never forget seeing the patient the day before the operation,
afraid to make any movement that might trigger another round of
pain, and seeing him two days after the operation, when I visited him
on my rounds; he had become a completely different person, relaxed,
happily engrossed in a game of cards with a hospital buddy. When
Lima asked him about the pain, he looked up and said quite happily
that “the pains were still the same” but that he felt fine. I remember
my surprise as Lima continued to check on the patient's mental
status. The operation had achieved little or nothing in terms of
sensory patterns corresponding to localized dysfunction of the tissues
that communicated with the trigeminal system.
The mental images of that dysfunction in the tissues remained

unchanged and that is why the patient could say that the pains
remained the same. And yet the operation had been a success.
He had certainly liquidated the emotional reactions that the pattern
of dysfunction in the tissues had previously produced.
The suffering was gone. The man's facial expression, voice, and
general appearance were not what we associate with pain.
This kind of dissociation between "sensation of pain" and

"affected by pain" has been confirmed in studies of groups of patients
who have undergone surgical operations to control pain. Recently,
Pierre Rainville, now doing research in my laboratory, has shown
that pain sensation and pain affect are clearly separable by ingenious
manipulation using hypnosis. Hypnotic suggestions designed to
specifically influence pain affect without altering pain sensation
modulate brain activity in the cingulate cortex, the same general
region that neurosurgeons can damage to relieve chronic and
intractable pain sufferers. Rainville has also shown that when
hypnotic suggestions were directed at the sensation of pain rather
than at the emotions associated with the pain, there were not only
changes in both unpleasantness and intensity, but also changes in
S1 (the primary somatosensory cortex) and in the cingulate cortex.24
Bottom line: that hypnotic suggestions targeting emotions following
pain, rather than following pain sensation, reduced emotion but not
pain sensation. of pain, also causing functional changes only in the
cingulate cortex; and that hypnotic suggestions targeting pain
sensation reduced both pain sensation and emotion, causing
functional changes in S1 and the cingulate cortex. You may have
had direct experience of what I am talking about if you have ever
taken beta-blockers to treat a cardiac arrhythmia problem or if you
have taken a Valium-type tranquilizer. These medications reduce
emotional reactivity and, if you are in pain at the time, reduce the
emotion caused by the pain.
We can verify the different biological statutes of pain and emotion

if we take into account the different things that interfere with one but
not with the other. For example, pain-causing stimuli can be specifically
reduced or blocked by analgesia. When the transmission of signals
leading to the representation of tissue dysfunction is blocked, neither
pain nor emotion follow. But it is possible to block the emotion and not
the pain. The excitement that would be caused by tissue damage can
be reduced by appropriate medications, such as Valium or beta-
blockers, or even by selective surgery. The perception of tissue
damage persists, but the blunting of the emotion prevents the suffering
that would otherwise have accompanied it.
And the pleasure? Is pleasure an emotion? Again I would prefer

to say no, although like pain, pleasure is closely related to emotion.
Like pain, pleasure is a constitutive source of certain emotions, as
well as triggering others. Just as pain is associated with negative
emotions such as anguish, fear, sadness and disgust, and whose
combination commonly constitutes what is called suffering, pleasure
is associated with many shades of happiness, pride and positive
emotions that they are in the background.
Pain and pleasure are part of the biological design with obvious
adaptive purposes, but they do their work in very different
circumstances. Pain is the perception of a sensory representation of
localized living tissue dysfunction. In most circumstances, when
damage is caused or is about to be caused to living tissue, warning
signals are produced that are transmitted both chemically and via
nerve fibers of types C and A-ÿ, creating adequate representations in
the central nervous system at very different levels. In other words, the
body is designed to respond to actual or impending loss of tissue
integrity through a particular type of signal.
These signals trigger lots of chemical responses

and neural across the gamut from localized white blood cell reactions
to concordant emotional responses to reflexes involving an entire limb.
Pleasure arises in a different medium. Returning to the simple

example of the pleasures associated with eating or drinking, we see
that these pleasures often begin with the detection of an imbalance,
such as low blood sugar or high osmotic pressure. The imbalance
leads to the state of hunger or thirst (this is what is known as the
motivating and driving state), which in turn leads to certain behaviors
that involve the search for food or water (also art and part of the
motivating and driving state). ), which ends up leading to the acts of
eating and drinking. Control of these various steps involves many
functional steps of different hierarchy and requires coordination of
internally produced chemicals and neural activity.25 The pleasurable
state may begin during the seeking process, in anticipation of the goal
of itself and increase when it is finally achieved.
But from saying to doing there is a long way. The search for food
or drink that lasts too long or is unsuccessful will not be accompanied
by pleasure or positive emotions at all. Or, if in the course of a
successful search the animal is prevented from reaching its goal, the
frustration of completion may end up causing anger. In the same way,
and as I noted in my commentary on the Greek tragedy, the relief or
suspension of the state of pain can cause the emergence of pleasure
and positive emotions.
The thing to keep in mind here is the possible interplay of pain,

pleasure, and attendant emotions, as well as the fact that they are
not mirror images of one another. They are asymmetric and different
physiological states, which underlie different qualities destined to
contribute to the solution of very complex problems.
different. (The duality of pain and pleasure should not make us

overlook the fact that there are more than two emotions, some of
which are aligned with pain and some with pleasure, although the
former is more abundant. The apparent symmetry of this insight fades
as behaviors become more complex over the course of evolution.) In
the case of pain, the problem is coping with the loss of integrity of
living tissue as a result of injury, whether caused by natural disease,
whether externally induced by predator attack or by accident. In the
case of pleasure, the problem is to lead the organism to attitudes and
behaviors conducive to maintaining its homeostasis. Interestingly,
pain, which I consider one of the main determinants of the course of
biological and cultural evolution, may have started as a consequence
of nature, as an attempt to deal with a problem that had already
occurred. My idea of pain used to be equivalent to placing a lock on
a door once the house has been burglarized, but Pierre Rainville has
suggested a better metaphor: placing a bodyguard on the door of
the house while repair the window. After all, pain does not arise to
prevent further injury, at least not yet, but to protect injured tissue and
facilitate tissue repair and prevent wound infection. On the other hand,
pleasure is all anticipation. It is related to the intelligent anticipation of
what can be done to avoid problems. At this elementary level, nature
discovered a wonderful solution: it seduces us into behaving well.
Pain and pleasure are thus part of two different genealogies of

the regulation of life. Pain is on the side of punishment and is
associated with behaviors such as withdrawal or immobilization. For
its part, pleasure is on the reward side and is associated with
behaviors such as searching and approaching.
Punishment causes organisms to close in on themselves,
immobilize and withdraw from their environment. The reward causes
the organisms to open up and open up to their environment, addressing it,
looking into it so that by doing so they increase both their chances of

survival and their vulnerability.
This fundamental duality is apparent in a creature as simple and
as probably unconscious as the sea anemone. His organism, lacking
a brain and equipped only with a simple nervous system, is little more
than a gut with two openings, moved by two sets of muscles, some
circular, others longitudinal. The circumstances surrounding the sea
anemone determine what its organism does: open up to the world like
a flower (at which point water and nutrients enter its body and supply
it with energy) or close into a small, flat, contracted bulge. , isolated
from the environment and almost imperceptible to others. The essence
of joy and sadness, approach and flight, vulnerability and safety, is as
apparent in this simple dichotomy of brainy behavior as it is in the
fickle emotional swings of a child at play.
THE SUBSTRATE FOR THE REPRESENTATION OF EMOTIONS AND

SENSATIONS
There is nothing vague, evasive, or nonspecific about the

responses I have just described as constitutive of emotion. The
substrate for the representation of emotions is a collection of neural
arrangements in a number of brain regions located mostly in the
subcortical nuclei of the brainstem, the hypothalamus, the basal
forebrain, and the amygdala.
As mandated by their status as devices, these representations are
implicit, latent, and unavailable to consciousness. Rather, they exist
as potential patterns of activity that arise in ensembles of neurons.
Once these neural dispositions are activated, certain consequences
follow. On the one hand, the activation pattern represents
within the brain a particular emotion as a "neural" object. On the other

hand, the activation pattern gives rise to explicit responses that modify
both the state of the body and the state of other brain regions. In
doing so, the responses create an emotional state, at which point an
outside observer can appreciate the emotional shock of the observed
organism. As regards the internal state of the organism in which the
emotion occurs, he has the emotion as a neural object (the activation
pattern at the induction sites) and as a sensation of the consequences
of that activation, a sensation, always that the resulting collections of
neural patterns become mental images.
The neural patterns that constitute the substrate of a sensation

occur in two types of biological changes: changes related to the state
of the body and changes related to the cognitive state. Changes
related to the state of the body are achieved by one of the following
two mechanisms. One assumes what I call "body loop." It uses
humoral signals (chemical messages carried by the bloodstream) and
neural signals (electrochemical messages carried by nerve pathways).
As a result of the two types of signal, the body landscape changes
and, as a consequence, is represented in the somatosensory
structures of the central nervous system, from the brain stem upwards.
The change of representation in the bodyscape may be partially
achieved by another mechanism that I call "body looping." In this
alternative mechanism, the representation of body-related changes is
created directly in sensory body maps, under the control of other
neural areas, such as the prefrontal cortices. It is "as if" the body has
really changed, even though it has not changed.
Changes related to cognitive status are no less interesting. They

occur when the process of emotion leads to the secretion of certain
chemicals in the nuclei of the basal forebrain, the hypothalamus, and
the stem.
brain, with the consequent distribution of these substances to various

other brain regions. When these nuclei release certain neuromodulators
(such as monoamines) in the cerebral cortex, thalamus, and basal
ganglia, they cause a variety of significant alterations in brain function.
The range of alterations is still not fully understood, but here are the
most important ones that I conceive: 1) the induction of specific
behaviors such as those used for mating, feeding, exploring, and
playing; 2) a change in the processing of bodily states in such a way
that bodily signals can be selectively eliminated or allowed to pass,
inhibited or highlighted, modifying their unpleasant or pleasant quality;
and 3) a change in the form of cognitive processing such that it can
change, for example, the rate of production of visual or auditory
images (from slow to fast or vice versa) or the focus of images (from
a sharp focus to another blurred); changes in rate of production or
focus are integral to emotions as different from sadness or joy.
Assuming all the proper structures are in place, the processes

we've reviewed earlier allow the organism to experience an emotion,
display it, and make images of it—that is, feel the emotion. But there
is nothing in this review to indicate how the organism that was feeling
the emotion that it was experiencing was to know. For an organism
to know that it experiences a sensation, it is necessary to add the
process of consciousness to the consequences of the processes of
emotion and sensation. In the following chapters, I will provide my
idea of what consciousness is and how it can work in such a way that
we "feel" a sensation.
CHAPTER THREE
CORE CONSCIOUSNESS
THE STUDY OF CONSCIOUSNESS
It is right for us scientists to bemoan the fact that consciousness

is an entirely personal and private matter and cannot be subjected to
the third-party observations that are commonplace in physics and
other branches of the life sciences.
However, we must face the fact that this is the way things are and
turn them in our favor. After all, we should not be tempted to try to
study consciousness exclusively from an external point of view based
on the fear that the internal point of view is completely flawed. The
study of human consciousness demands external and internal
perspectives.
Although consciousness research is doomed to a certain indirect
approach, this limitation is not restricted to consciousness. It applies
to all other cognitive phenomena. The acts of behavior (kicks,
punches, and words) are good expressions of that private process
that is the mind, but they are not the same as the mind. By the same
token, electroencephalograms and functional MRI scans capture
correlates of the mind, but those correlates are not the mind itself.
However, an unavoidably roundabout approach does not equate to
eternal ignorance of underlying mental structures or neural
mechanisms. The fact that mental images are only accessible to their
possessing organism does not prevent their characterization, does
not deny their support in an organic substance and does not prevent
each time
Let's close the fence more on the specificities of that substance.

Purists may be concerned about this based on the idea that what
someone else can't see can't be scientifically reliable, but it really
shouldn't concern anyone. This state of affairs should not prevent us
from treating subjective phenomena scientifically. Whether we like it
or not, all the contents of our minds are subjective, and the power of
science consists precisely in its ability to objectively verify the
consistency of many individual subjectivities.
Consciousness occurs within an organism rather than in public,

but it is associated with a number of public manifestations. These
manifestations do not describe the internal process with the same
immediacy as a sentence translates a thought, and yet these
manifestations are there, available for observation, as correlates and
revealing signs of the presence of consciousness. Based on what we
know about the private human mind and what we know and can
observe about human behavior, it is possible to establish a three-way
link between: 1) certain external manifestations (for example,
wakefulness, background emotions, attention, specific behaviors); 2)
the corresponding internal manifestations of the human being who
has such behaviors, as reported by himself; and 3) the internal
manifestations that we as observers can verify in ourselves when we
see ourselves in circumstances equivalent to those of the observed
individual. This triple bind allows us to make reasonable inferences
about human intimate states based on external behavior.1
The solution to the methodological problem posed by the intimacy

of consciousness lies in a natural human capacity, that of constantly
theorizing about the mental state of others from the observation of
their behavior, of what they tell us about their mental states and of
the contrast between one and the other, in view of our own comparable
experiences. What
student of mind and behavior, I have turned a hobby (being curious

about the minds of others) into a professional activity, which means
nothing more than that I have obsessed over it and taken notes.
Interestingly, compared to the specialists, popular culture seems

to have less of a problem with the intimate perspective of
consciousness, as brilliantly demonstrated in Woody Allen's film
Taking Harry Apart. You may have seen the movie, but in case you
haven't, here's my version of what happens. In the middle of a "movie
within a movie" scene and describing the shooting of a scene from a
movie, the cameraman realizes that the image of the actor he is
shooting is blurred. Naturally, he first attributes the problem to a
mistake in his focus control, and when he can't correct it, he begins
to wonder if it's not the focus mechanism that is failing. But the
mechanism is fine and since it doesn't improve anything, the
cameraman then thinks about the state of the lens. Won't it be dirty
and make everything look blurry? All in all, it turns out that the lens is
fine too and perfectly clean. In the ensuing commotion, everyone
suddenly realizes that the difficulty has nothing to do with the camera
but with the actor in question (Mel, played by Robin Williams). It is
the actor himself who is out of focus! It is inherently out of focus and
everyone who looks at it sees a blurred image; when they look at
something other than Mel they see a sharp image. The movie-within-
a-movie actor has been stricken with an illness that makes everyone
around him, including his perplexed family and stunned doctor, see
him out of focus.
The reason the audience laughs has to do with the sheer

absurdity of the idea, with the violation of a fundamental property of
consciousness: its personal, intimate, first person singular view of
things. Blur and blur are not properties of objects, except in a
metaphorical sense.
Even when we put a screen between us and an object
that modifies its perception, or what is the same, when the lenses of
our glasses are dirty, the blurriness is not in the object. Blurring and
out of focus come largely from our conscious perspective in
perception. Under normal circumstances, blurring and defocusing
occur within a person's body, due to a number of causes that arise
at many different physiological levels, from the eye to the brain,
passing through the nerves that carry the signals of each other. The
others, those who are close to the one who "seems blurry to me" do
not share my blurriness or my out of focus. The scene occurs
because no one can get Mel back into focus. Fuzziness has become
an external property of a living being rather than a personally
constructed trait from observation.
The contemporary approach to the study of the biological bases

of the intimate human mind involves two steps. The first step is to
observe and measure the actions of the experimental subject, or to
collect and measure reports about the internal experience that the
subject itself provides, or both. The second step is to relate the
collected evidence to the measured manifestations of one of the
neurobiological phenomena that we are beginning to understand at
the molecular, neuronal, neural circuit, or circuit system level.
The approach is based on the following assumptions: that the

processes of the mind, including those of consciousness, are based
on brain activity; that the brain is part of the complete organism with
which it is continually related; and that, as human beings, and despite
remarkably individual traits that make us unique, we share similar
biological characteristics in terms of the structure, organization and
functioning of our organisms.
The limits of the first solution outlined above can be greatly

expanded when we shift the focus to humans with neurological
disease and suffering from mental and behavioral impairments
caused by physical damage.
brain and selective brain dysfunctions; the type of problem that arises as a result of, for
example, an attack.
This approach, known as the lesion method, allows us to do with consciousness what
we have been doing for so long with vision, language, or memory: investigate a failure
of behavior, relate it to failures of mental states (cognition), and relate both with a
localized brain injury (a restricted area of brain damage) or with a recording of abnormal
electrical activity provided by an electroencephalogram or with a recording of electrical
potentials (brain wave test) or with an abnormality on a functional imaging scanner
(such as a PET orwith
an the
fMR).
opportunity
A certain
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well as anatomically identifiable areas with brain dysfunction, with which we can study
many aspects of the mind, especially those that are less transparent. Armed with the
corresponding conclusions, it is possible to put hypotheses to the test, validate them or
modify them according to the results and test perfected hypotheses in other neurological
patients or in health controls.
Research on patients with neurological diseases has shaped my views on

consciousness more than any other source of evidence. However, before reflecting on
my observations in neurological patients with altered consciousness, it is appropriate
to dedicate a few words to the manifestations of consciousness that reveal it to the
outside.
THE MUSIC OF BEHAVIOR AND THE EXTERNAL MANIFESTATIONS OF

AWARENESS
Consistent and predictable external manifestations of

consciousness are easily identifiable and measurable. For example,
we know that organisms in a normal state of consciousness are
awake, attentive to stimuli in their environment, and behave in a way
that is appropriate to the context and to what seems to us to be the
object of their existence. Appropriate behaviors encompass both the
underlying emotions that I have described above and the specific
actions or stimuli that occur in a certain area. An experienced observer
can assess these correlates of consciousness in a relatively short
time (perhaps even ten minutes if the circumstances are right,
although I have to add that experts can be fooled). The presence or
absence of wakefulness can be established by direct observation of
the organism: the eyes must be open, the muscles must have
sufficient tone to allow movement. The ability to attend to stimuli can
be established from the body's ability to orient itself towards them and
thus we can observe eye movements, head movements and patterns
of movement of extremities and of the whole body as the organism
responds to the very diverse sensory stimuli and is related within an
environment. The presence of background emotion can be established
from the nature of facial expressions and from the dynamic profile of
limb movements and postures. The adequacy and appropriateness
of a given behavior can be assessed by considering the context of
the situation, be it natural or experiential, and determining whether
the organism's responses to stimuli and self-initiated actions are
appropriate in that context.
Although all of these manifestations can be elicited with the

appropriate stimuli, as well as observed, videotaped, and measured
with various devices, I must emphasize that the qualitative judgments
of the alert observer are an essential tool in behavioral analysis. What
he faces
observer is decomposable by expert analysis, but first and foremost

it is a composite, a concurrence in time of different aspects, exhibited
by a single organism and, we do not know how, connected by a single
objective.
It can be helpful to think of the behavior of an organism as the
performance of an orchestral piece whose score is invented as the
piece progresses. Just as the music we hear is the result of many
groups of instruments playing at the same time, the behavior of an
organism is the result of various biological systems playing together.
Different groups of instruments produce different types of sound and
play different melodies. They may play non-stop throughout a piece
or absent themselves at times, sometimes for a certain number of
bars. The same goes for the behavior of an organism. Some biological
systems produce behaviors that are present continuously, while
others produce behaviors that may or may not be present at a given
time. The main ideas that I wish to highlight here are: First, that the
behavior that we observe in a living organism is not the result of a
single melodic line, but rather the result of the integration of diverse
melodic lines in each unit of time that we select for observe: if we
were imaginary conductors who saw the supposed score of the
behavior of the organism, we would see the different musical parts
vertically, measure by measure. Second, that some of the components
of the behavior are always present, forming the continuous basis of
the interpretation, while others are only present during certain periods
of the interpretation; the "behavioral score" would account for the
entrance of a given behavior at a given bar as well as its ending a
few bars later, just as the conductor's score reflects the beginnings
and endings of piano solos within movements. of a concert. Third,
that despite
the various components, the behavioral product of each moment, is

an integrated whole, a fusion of contributions not unlike the polyphonic
fusion of an orchestral performance. From the basic feature that I
have already indicated, the concurrence in time, something arises
that is not specified in any of the parts.
When we consider human behavior in the pages that follow, I
ask you to think of a variety of parallel lines that develop over time.
Wakefulness, background emotions and lower attention will be there
continuously; they are there from the moment we wake up to the
moment we fall asleep. Specific emotions, focused attention, and
specific sequences of actions (behaviors) will appear from time to
time, as appropriate to the circumstances. The same can be said of
verbal emissions, which are a variant of behavior.
Let us now consider an expansion of this metaphor in the mind

of the person whose interpretation we are observing. What I propose
is that there is also an orchestral score in your inner mind, although
in this case the concurrent musical parts that appear together
correspond to mental streams of images. These currents are for the
most part the internal and cognitive reverse of the behaviors that we
observe. Some images occur a fraction of the time before the
behaviors occur, for example the mental image of an idea that we
then put into words. Other images occur immediately after, for
example feeling an emotion that we have just manifested. Of course
there are musical parts for the waking state and continuously making
images also for the representation of concrete objects and events, as
well as the words that indicate them; there is also a part for the
sensations of the various emotions that the organism shows. However,
there is another part in the orchestral score
internal for which there is no precise external counterpart: that part is

the sense of being, the basic component of any notion of consciousness.
With this metaphor in mind, we can imagine the sense of being

as an additional part that wordlessly informs the mind of the very
existence of the individual organism in which that mind develops, as
well as that the organism is engaged in relating to objects. inside or
around you. This knowledge alters the course of mental process and
the course of external behavior. Its intimate presence, which is only
directly available to its owner, can be inferred by the external observer
from the influence it exerts on external behaviors rather than from its
own direct behavior. Wakefulness, background emotion, and low-
intensity attention are thus external signs of internal conditions that
are compatible with the occurrence of consciousness. On the other
hand, specific emotions, focused and sustained attention, and goal-
directed and context-appropriate behaviors over long periods of time
are good indications that awareness is indeed building in the subject
we are observing. even though we, as external observers, cannot
directly observe consciousness.
Table 3.1. The Behavior Score

Vigil
Wakefulness and awareness often go together, although the

pairing can be broken in two rare circumstances. An exception is
when we are asleep and dreaming. Obviously we are not awake while
we dream asleep and yet we have some awareness of the events
that pass through our mind. The memory we form of the last fragments
of sleep before waking indicates that a certain consciousness was
"on the march." Another reversal of this usual pairing, in this case
dramatic, can occur when we are awake but deprived of consciousness.
Fortunately, this only occurs in the neurological diseases I am about
to describe.
Wakefulness is best described if we look at it from the transition

from sleep to wakefulness. The indelible image of that transition that
always comes to mind is Winnie in Beckett's Happy Days, when the
bell rings at the beginning of the first act: Winnie opens her eyes to
the audience and says, "Another divine day." And she wakes up, like
a sunrise, in a state that allows her brain to form images of her
surroundings: bag, toothbrush, Willie's rustling as he moves, her own
body (which she tells us is not it hurts a lot that day, "practically
nothing"). That vigil concludes at the end of the day for Winnie when
the bell closes the first act.
When wakefulness is removed, leaving aside dreams while

asleep, consciousness is eliminated. Examples of this pairing are
dreamless sleep, anesthesia, and coma.
But wakefulness is not the same as consciousness. In the waking state,
the brain and mind are "on the go" and images of the interior of the
organism as well as the environment around the organism are being formed.
Of course, reflexes can be connected (you don't need awareness or
wakefulness for reflex activity), and low-intensity attention can be
drawn to stimuli that fit.
to the basic needs of the body. And yet awareness may be lacking.
Patients with some neurological diseases that will be discussed in
this chapter are in a waking state and yet lack what central
consciousness would have added to their thought process: images of
self-centered knowing.
attention and deliberate behavior
There is more to Winnie's behavior than mere wakefulness. She

is oriented towards objects and focuses on them as needed. Eyes,
head, neck, torso and arms move in a coordinated dance that
establishes an unequivocal relationship between Winnie and certain
stimuli in her environment: the bag, the toothbrush, the rustling that
Willie makes behind her back.
The presence of attention to an external object usually means the
presence of awareness, although not necessarily. Patients with so-
called akinetic mutism, who have abnormal consciousness, may pay
fleeting , low-level attention to a conspicuous object or event , such
as an observer calling them by name. Attention betrays the presence
of normal consciousness only when it can be sustained for a period
of time in relation to objects that are necessary for proper behavior in
a certain context: which means minutes and hours rather than
seconds. In other words, the extension of time and the focus on the
appropriate objects define the type of attention that is indicative of
awareness.
Overt inattention to an external object does not necessarily

negate the presence of consciousness and may instead indicate that
attention is directed toward an internal object. Distracted teachers
and dreamy teenagers display this "symptom" all the time. Fortunately,
this condition is in your
most transitory. Sustained and complete failure of attention is

associated with the dissolution of consciousness, as occurs with
drowsiness, states of confusion, and stupor.
Sentient creatures focus on certain objects and are attentive to
certain stimuli, something that fits quite well with our own point of
view when we think about what goes through our minds in similar
situations. We can all agree that attention and consciousness are
related, but the nature of that relationship is a debatable matter. My
point of view is that both consciousness and attention occur in levels
and degrees, not as monoliths, and influence each other in an upward
spiral. Low-intensity attention precedes central awareness; It is
necessary to start the process that originates it. But the process of
central awareness results in drawing higher attention to a focus.
When I attend to an acquaintance who visits me in the office, I do so
under the influence of my central consciousness. I could only have
caused that consciousness because my organism was driven by low-
intensity attention to process certain features of the environment that
are important to organisms like me, namely, self-moving creatures
with human faces. As the process continued, the central consciousness
helped to focus attention on the particular object that started the
organism in the first place.
But back to Winnie. What we next realize is that he is behaving

in a goal-oriented manner in relation to the stimuli on which he is
concentrating. It might not, given that Winnie is a character in a
Beckett play, but it does. In effect, their behavior is part of an
immediately recognizable plan that only an organism capable of
knowing its past, its present, and its anticipated future could formulate.
The behavior corresponds to that plan for a long period of time: hours,
to tell the truth. That functioning for a purpose and the adequacy of
the behavior of
Winnie demand the presence of conscience even if conscience does

not guarantee proper behavior in the end: there are perfectly
conscientious idiots who can behave with utter impropriety.
One thing especially noteworthy about sustained and appropriate

behavior is that specific behaviors are accompanied by a flow of
emotional states as part of their display. The background emotions
that we discussed in the previous chapter continually underline the
subject's actions. Telltale signs include overall body posture and
range of motion of the limbs relative to the trunk; the spatial profile of
limb movements, which can be smooth or jerky; the congruence of
the movements that occur in different body locations, such as face,
hands and legs; and last, and perhaps most importantly, the animation
of the face. Even when the observed subject speaks, the emotional
aspects of the communication and the content of the words and
phrases said are separate. «Yes», «No», from «Hello» to «Good
morning» through «Goodbye» are usually said with an inflection of
underlying emotion. Emotion is an example of prosody, the musical
or tonal accompaniment of the speech sounds that make up words.
Prosody can express not only background emotions but also concrete
emotions.
We can say to someone, in the most loving tone possible, "Come on,
go away!" or say "I'm glad to see you" with a prosody that unmistakably
registers our indifference.
Furthermore, concrete emotions often follow the stimuli or actions
that apparently motivate them in the subject, as judged by the viewer
from his or her perspective. Indeed, normal human behavior exhibits
a continuity of emotions induced by a continuity of thoughts. The
content of such thoughts, and generally there are other simultaneous
and parallel contents, encompasses the objects with which
the organism is in relation at that moment or to objects brought to

memory, as well as to feelings of emotion that have just occurred. In
turn, many of these "currents" of thought (of real objects, of
remembered objects, and of feelings) can induce emotions, both
background and secondary, with or without recognition of the subject.
The continuous display of emotions derives from this overabundance
of inducers, known or not, simple and not so simple.
The continuity of the melodic line of background emotion is an

important fact that must be taken into account in our observation of
normal human behavior. When we observe someone whose central
consciousness is intact, long before half a word is said, we already
find ourselves presupposing the mental state of the other. Correct or
not, some of these presuppositions are based on the continuity of
emotional signals available in the subject's behavior.
A note of caution about confusing terminology: The terms

alertness and excitability are sometimes used interchangeably with
wakefulness, attention, and even awareness, which they shouldn't be.
Alertness is often used instead of wakefulness, as when we say that
we feel "alert" or when we believe that someone is in such a situation.
For my purposes, the term alertness should indicate that the subject
is not simply awake but apparently ready to perceive and act, that is,
oriented. The proper meaning of alert is somewhere between "awake"
and "attentive."
It is easier to define the term excitability. It denotes the presence

of signals of autonomic nervous system activation, such as changes
in skin color (blushing or paleness), behavior of epidermal hair (the
creeps!), diameter of the pupils ( major or minor), sweat, sexual
erection, and so on, which can reasonably encompass nonspecialized
terms such as arousal. You can be awake, alert, and fully aware
without looking "excited"
in this sense, but we all know that our organisms can be "excited" in
this sense during sleep, when we are not awake, attentive or aware.
You can even excite comatose patients even if they don't realize it.
Curious right?
THE STUDY OF CONSCIOUSNESS FROM ITS ABSENCE
We can ask ourselves how we are going to be able to say anything,

from a personal perspective, about the absence of consciousness,
considering that the absence of knowledge and being would prevent us
from experiencing that absence. The answer is that we come close to
experiencing that absence of awareness in a few circumstances. Think
of the brief moments in which we regain consciousness after an episode
of loss of consciousness caused by fainting or anesthesia; or, more
benignly, in those fleeting moments that precede full awakening from
the deep, restorative sleep that follows fatigue. In those fleeting
moments we have a glimpse of the impoverished state of mind that has
preceded them. Images of people and things and places are forming
around us, and yet for a brief period that can seem like an eternity, we
lack a sense of self and seemingly have no thoughts of our own. A
fraction of a second later, our sense of being is "on" and yes, we
vaguely assume that the images belong to us even though all the details
don't quite fit yet. It takes a good while longer for the autobiographical
being to be rearranged again as a process and for the situation to be
perfectly explained.
Still, the question remains as to how we can glimpse such a state

of unconscious mental impoverishment by not being conscious during
such a state. Of course we have such glimpses and I suspect that the
reason we have them
it is that we lack, during those fleeting moments, the memory of any

experience of the moments that have occurred immediately before
the transition. Our conscious experience usually includes a brief
memory of what we feel as "just before" that is linked to what we
naively believe to be "now." That memory describes the sensation of
being to whom certain knowledge is attributed.
Immediately after waking up, however, the brief memory that would
have preserved that earlier moment for the benefit of the present
moment is not available, for the simple reason that there was no
conscious experience to memorize. Our insight into these anomalous
states therefore reveals an important fact: the continuity of normal
consciousness requires a brief recall, on the order of a fraction of a
second, a trivial feat for the human brain, whose habitual memory of
short-term events can last about sixty seconds.
The most extreme variants of loss of consciousness (coma,

persistent vegetative state, deep sleep, heavy anesthesia) leave little
room for behavioral analysis because nearly all manifestations of the
"behavioral score" we have seen have been abolished. .2
Consequently, almost all internal manifestations of the 'cognitive
score' are believed to be abolished as well. The idea that the
phenomena of consciousness and even mental phenomena are put
on hold in such situations is an intuition based on firm reflections on
our own condition and on equally solid observations of the behavior
of others. This idea is also supported by the very few but valuable
reports of people regaining consciousness after being in a coma
(much of what we can remember looks like the application of an
anesthetic) and the return to knowing, but nothing is remembered of
the intermediate period, which can last for weeks or months. Given
all the evidence, it is legitimate to suppose that little or nothing
occurred in the mind under such circumstances.3
However, two other patient groups allow ample opportunity for

behavior analysis and stand out for the influence their study had on
my thinking about consciousness.
One of the groups is made up of patients with a complicated
phenomenon called epileptic automatism. The other group brings
together patients who, as a result of various neurological diseases,
develop a condition known by an umbrella term that is akinetic
mutism. In both groups, central consciousness and extended
consciousness are profoundly affected, yet not all behaviors described
in the "behavioral score" are abolished, thus leaving room for some
intervention by the observer and the analysis of some residual
behavior. .4
Epileptic automatisms can be like a scalpel and segregate

consciousness from things in consciousness. Automatisms can occur
during attacks or immediately after them. The episodes that interest
me the most are those associated with absence seizures, although
automatisms are also studied in association with so-called temporal
lobe seizures. Absence seizures are one of the main varieties of
epilepsy, in which consciousness is momentarily suspended along
with emotion, attention, and appropriate behavior. The disturbance is
accompanied by a typical electrical abnormality on the EEG. Absence
seizures are of great value to the student of consciousness, and the
characteristic variant of absence seizure is, in fact, one of the purest
examples of loss of consciousness: the term absence shortens the
expression "absence of consciousness." The absence automatism
that follows a particularly long absence seizure is probably the purest
example of all.
If we were to talk to someone prone to absence seizures and

absence automatisms, here's what might happen if one of those
episodes started. Suddenly, while carrying on a perfectly reasonable
conversation, the patient would stop mid-sentence, freeze whatever
movement he was making, stare blankly, staring blankly at nothing,
his face blank of expression, like a meaningless mask The patient
would remain awake. Muscle tone would still exist. He wouldn't fall or
have seizures or drop whatever he was holding. This state of
suspended animation could last no more than three seconds (a much
longer time than can be imagined when contemplating such an attack)
or last for tens of seconds. The longer it lasts, the more likely it is that
the absence itself will be followed by absence automatism, which, in
turn, can last a few seconds or many. When the automatism begins,
the events are even more intriguing. The situation isn't much different
from releasing the video pause button or when a stuck home projector
starts up again. The show goes on. As the patient thaws, he looks
around (he may not be looking at us but at something around us), his
face is still blank, with no signs of decipherable expression, he drinks
from the glass on the table, he smacks his lips, touches his clothes,
gets up, turns, goes to the door, opens it, hesitates on the threshold
and goes down the hall.
We have already recovered and we have risen to follow him and

contemplate the end of the episode. One of the following possibilities
could occur. The most likely would be for the patient to stop and
stand in the hallway, appearing confused; or to sit down, if there is a
bench. But the patient could also enter another room or continue
walking. The most extreme variant of this type of episode would be
what is known as "epileptic fugue", in which the patient could leave
the building and walk down the street. To a good observer it would
have a
strange looking and he would seem confused, but he could continue

on his way without anything bad happening to him. Along the trajectory
followed in any of these possibilities, within a few seconds usually,
much more rarely after a few minutes, the episode of automatism
would come to an end and the patient would be left bewildered,
wherever he was at that time. moment. Consciousness would have
returned just as suddenly as it had gone and we would have to be
there to explain the situation to him and get him back to where we
were before the episode started.
The patient would have no recollection of the elapsed period.

You would not know then and will never know what your body had
been doing during that episode. When one of these crises ends,
these patients have no recollection of what happened during the crisis
or during the duration of the crisis in the period of automatism. They
remember what happened before the attack and can retrieve those
contents of their memory, a clear indication that their learning
mechanisms were intact before the attack. They are immediately
aware of what is happening once the attack is over, a sign that the
attack has not done irreparable damage to their learning. But the
events that have occurred during the period of the attack have not
been fixed in memory or, if they have been fixed, they are not
recoverable.
Had we interrupted the patient at any point in his crisis, he would
have looked at us with utter bewilderment or perhaps indifference. He
would not have known who we were, either spontaneously or even if
we asked him specifically; I wouldn't have known who he was or what
he was doing; and he would simply have kept us away with a vague
gesture, barely looking at us. The contents that make up the conscious
mind would be missing, with which a verbal communication could not
be produced, in the same way that an act of high intelligence could
not be produced. He would have stayed awake and attentive enough
to process the object that entered his mind.
perceptual field but, as far as we can deduce from the situation, he would
not have anything else in mind. I would have no plans, nor would I think
about things in advance, nor would I have the feeling of being an
organism that wishes, that wants, that weighs, that believes. There would
have been no sense of being, no identifiable person with a past or
anticipated future: specifically, there would be neither a central being nor
an autobiographical being.
In such circumstances, it is the presence of an object that prompts
the immediately following action, an action that would be appropriate in
the microcontext of the moment: drink from the glass, open the door. But
that action, and others, would not be appropriate in the broader context
of the circumstances in which the patient moves. When one watches
how actions unfold, one realizes that they are devoid of ultimate purpose
and inappropriate for an individual in such a situation.
Yet there would have been an unmistakable wakefulness: the eyes

would have been open, muscle tone would have been maintained.
There would have been some ability to create neural cues and, possibly,
images: the objects around the patient would have to be sufficiently
represented in visual or tactile terms for him to be able to carry out these
actions successfully. And there would also have been attention, not
superior attention like we now have, but enough attention so that the
organism's perceptual and motor devices could focus sufficiently on an
object and well enough for sensory images to be properly formed and
The movements related to these images, such as the visual image of a
wall or the tactile image of a glass from which the patient could drink, will
be executed with sufficient precision.
In other words: the patient would have had some elementary

aspects of the mind, he would have had some contents in such a mind,
related to the objects around him, but he would not have had normal
consciousness. I would not have developed
parallel to the image of the objects around him, an image of that being-
centered awareness: neither a heightened image of the objects he
was relating to, nor a sense of the connection there might be between
what had gone before of a given moment or of what could happen the
next moment.
The dissociation between impaired consciousness and the ability

to form neural patterns of objects, surprising as it may seem, has been
substantiated by intriguing new evidence. A patient in a persistent
vegetative state, a milder form of coma in which signs of wakefulness
are shown but in which consciousness is severely impaired, was
studied using a functional graphic scanner while photographs of
human faces were projected onto her retinas. who were familiar to
him. The result was the activation of a region of the occipitotemporal
cortices known to be activated by the perception of faces by normal,
awake, and conscious people. In such a way that even without
consciousness, the brain can process sensory signals in various
neural repeaters and cause the activation of at least some areas that
are normally involved in the processes of perception.5
Observing an absence automatism crisis we would have observed

the complex behaviors of an organism deprived of all expanded
consciousness and of everything except perhaps the palest form of
central consciousness. We can only try to imagine what remains of a
mind from which being and knowing have been removed, perhaps a
mind peppered with things to be known but never really known, things
never really owned, a mind devoid of the machine of deliberate acts.
Let me conclude by commenting on the fact that throughout that

episode emotion did not make an appearance. Suspension of emotion
is an important signal in absence seizures and absence automatisms.
Emotion is also absent in the akinetic mutisms described
in the next section. The lack of emotion (neither background emotions

nor specific emotions) is conspicuous, but has not been highlighted
in the texts. Reflecting on this discovery now, many years after I first
became aware of it, I venture that perhaps the absence of emotion is
a reliable correlate of defective central consciousness, perhaps to
the same extent that it is virtually always believed. associates the
conscious state with the presence of a certain degree of continuous
emotionality. Another related discovery occurs regularly during that
natural experiment in consciousness that we call dreams. Deep sleep
is not accompanied by emotional expressions, but in dream sleep,
during which the mind returns in that weird way, emotional expressions
are easily detected in humans and animals.
Discovering parallel damage between consciousness and

emotion will seem all the more striking when we consider that patients
in whom central consciousness is intact but extended consciousness
is limited have normal and recognizable background and primary
emotions. Emotions and core awareness often go together, in the
literal sense, being present at the same time or absent at the same
time.6 The lack of emotion is surprising given that, as we have seen,
emotions can be triggered unconsciously, with unattended
thoughts or with unknown predispositions, as well as imperceptible
aspects of our bodily states. The lack of emotion when central
consciousness fades might be briefly explained by suggesting that
both emotions and central consciousness require, in part, the same
neural substrates and that strategically placed dysfunction puts both
kinds of processing at odds. Shared substrates include the set of
neural structures that support the protoser (to be described in Chapter
5), structures that regulate and represent the internal states of the
body. For me, the lack of emotion, from the background emotion to
the levels
levels of emotion, it is a sign that certain important bodily regulatory

mechanisms have failed. The central consciousness is close,
functionally speaking, to the broken mechanisms, interwoven with
them and therefore fails like them. There is not such an intimate
functional relationship between emotional processing and expanded
consciousness. Therefore, as indicated in Chapter 7, damage to
extended consciousness is not accompanied by a failure of emotion.
Subjects with normal consciousness can become aware of their

emotions in the form of sensations, and these sensations, in turn, can
originate a new melodic line of emotions that confers on behavior the
features that we so easily recognize as characteristic of sentient life.
In a pathology, the suspension of that reverberating cycle of emotion
that leads to sensation, and which in turn leads to emotion, deprives
behavior of a first-order signal revealing sentience and gives rise to
the observer the idea that something strange happens in the mind of
the observed subject. I would not be surprised to discover that the
reason we so confidently attribute consciousness to the minds of
certain animals, especially domestic animals, is due to the highly
motivated flow of emotions they exhibit and our automatic and
reasonable assumption that such emotions are from within. then
caused by sensations that could only affect behavior in a sentient
creature. I will continue with this issue later.
Another important source of information regarding impaired

consciousness comes from the study of patients with a disease known
by the umbrella term akinetic mutism. Akinesia or akinesis are
technical terms for lack of movement, usually due to an inability to
initiate movement, although slow execution of movement usually
occurs; mutism, as indicated by the
word, indicates the absence of speech. As usual, the terms suggest

what is happening externally or not, but overlook the view of the
internal. Internally, and based on the available evidence, consciousness
is very severely diminished or even completely suspended. The
problem of so-called akinetic mutism has fascinated me for years,
and I have spent many hours observing these patients, in their
hospital beds or in my laboratory, studying their scans and EEGs,
and patiently waiting for their mutism to end so that I might talk to
them. they. The history of one of my patients with this disease will
give an idea of what happens.
The attack suffered by this patient, whom I will call L, damaged

the inner and superior regions of the frontal lobes of both hemispheres.
An area known as the cingulate cortex was damaged, as were other
nearby areas. The patient had suddenly become immobile and
speechless and was generally to be immobile and speechless for
most of the next six months. He was in bed, usually with his eyes
open, but with a vacant facial expression. From time to time he
became aware of the existence of a moving object (for example,
myself moving around his bed) and followed it for a few moments,
with his eyes and head, but soon returned to his gaze. steady, calm
and unfocused. The term neutral helps to convey the equanimity of
his expression, although once one focused on his eyes, the word
vacant was more appropriate.
It was there but not there.

His body had no more animation than his face. He could make a
normal movement with his arm and hand, for example, to cover
himself with the sheets, but in general his limbs were at rest. Neither
body nor face ever expressed any emotion of any kind, neither deep,
nor primary nor secondary, although he was offered, every day, not a
few inducers in attempts at focused conversations or in informal jokes
at the bedside of doctors , nurses, medical students, friends and
family members. Absolute emotional neutrality reigned, by which is

meant that there was not only no response to external inducers but
also to internal ones, those that could have been present in their
thoughts but, as it turns out, were not.
When asked about her condition, she was almost invariably

silent, although, after much cajoling, she was able to say her name,
just once, and then return to her silence. He had nothing to say about
the events that led to his admission, nothing to comment on his past
or his present. He did not react any more to the presence of relatives
and friends than to the presence of doctors and nurses. Neither the
photographs nor the songs, neither the darkness nor the bright light,
nor the sound of thunder nor the sound of rain pushed her to react.
She was never bothered by my insistent and repetitive questioning,
she never showed an iota of concern for herself or for anything.
Months later, when he came out of his state of reduced existence

and gradually began to answer some questions, he would clarify the
enigma of his state of mind. Contrary to what a casual observer might
have thought, his mind had not been imprisoned in the cell of his
immobility. Rather, it seemed that he had had almost no mind and
nothing like central consciousness, let alone expanded consciousness.
The passivity of his face and body was the appropriate reflection of
his lack of mental animation. He had no recollection of any particular
experience during his long period of silence; never felt afraid; she
never felt anxious; never wanted to communicate.
In the period immediately preceding the first answers he gave me, a

matter of days perhaps, he vaguely remembered being asked
questions but felt that he really had nothing to say and that did not
cause him any pain either. Nothing forced her not to express herself.
Unlike patients with the locked-in syndrome (presented in Chapter

8), L appears to have had no sense of being of his environment or any
sense of knowing during most of his long waking sleep. Even during his
slow awakening it is likely that his sense of being was impaired. Unlike
the patients with locked-in syndrome, but in the same way as the epileptic
patients described above and the patients I will describe in the next
section, L would have been able to move perfectly (limbs, eyes, vocal
apparatus) had he had a conscious mind formulating a plan and ordering
a movement. But I didn't have it. Although he probably had some imagery
(it is hard to imagine how he managed to track an object or pull the
covers up to the touch, accurately, had he only had reflexes), he seems
to have had no discrete thinking, reasoning, or planning, and that there
was also no emotional reaction to any mental content. That momentous
set of flaws had been carried outward in the form of a neutral facial
expression, a practical arrest of bodily movement, and mutism.
Again the emotion was missing.
Consciousness is also impaired in some patients with advanced

Alzheimer's disease, and in a manner similar to that just described for
akinetic mutism. In the early stages of the disease, memory loss
dominates and consciousness remains intact, but as the devastation of
Alzheimer's deepens, we often find a progressive degradation of
consciousness.
Unfortunately, textbooks and lay descriptions of Alzheimer's stress

memory loss and early preservation of consciousness and often neglect
to mention this important aspect of the disease.
The decline affects the extended consciousness first,

progressively narrowing its scope to the point where virtually any
semblance of autobiography disappears. Later, it is the turn of the
central consciousness, to diminish to a point where even the simple
sense of being is no longer present. Wakefulness is maintained, and
patients respond to people and objects in elemental ways (a glance
or touch, holding an object), but there is no trace that these responses
stem from actual knowing.
In a matter of a few seconds, the continuity of patient care is

interrupted and the senselessness of actions becomes apparent.
I have seen this disintegration occur in many Alzheimer's

patients, and never in such pain as when it occurred to a dear friend
who was also one of the most remarkable philosophers of his
generation, and whose intellectual brilliance concealed his mental
decline from all but the world. to those closest to you. The last time I
saw him, he didn't say a word or give any sign of recognizing either
his wife or me. His eyes, emptied of expression from within, would
rest on a person or an object for a few seconds, without his face or
body showing any reaction. He showed no sign of emotion, positive
or negative. And yet, he knew how to move his wheelchair, spinning
around the room, without predictable orientation, approaching the
large window, for example, and staring at nothing in particular.
I once saw him approach the only nearly empty bookcase in the
room, reach to a shelf about arm's length from his chair, and pick up
a folded piece of paper. It was a well-worn 8 x 10 photo on glossy
paper, folded in four. He slowly lowered her onto his lap; he unfolded
it slowly; and he stared for a long time at that beautiful face, that of
his smiling wife, then divided into four quadrants by the deep folds of
that folded paper
countless times. I looked but did not see. There was no spark of
recognition at any time, no connection was made between the portrait
and the live model who sat in front of it, a very short distance away;
nor did he make any connection with me, who had taken the photo
ten years ago, in a moment of shared joy. He had regularly folded
and unfolded the photograph from the very beginning of the illness,
when he was still aware that something was missing, perhaps in a
desperate attempt to cling to the certainty of what it was. On that
occasion it had already become an unconscious ritual, carried out
with the same delay, in the same silence, with the same lack of
affective resonance. In the midst of the sadness of that moment I was
glad that he could not know.
Reflection on these examples of disturbed consciousness reveals

the following facts: First, there is a very sharp separation between
wakefulness, low-intensity attention, and appropriate behaviors,
on the one hand, that can survive disturbed consciousness, and
emotion, on the other. , which is lost along with the feeling of knowing
and being.
This defect of knowing and being and recognizably motivated emotion
goes hand in hand with defects in planning, high-intensity attention,
and appropriate and sustained behaviors. The disengagement of
functions that we can observe in these cases exposes a stratification
of subcomponents that would have been difficult to capture, let alone
separate, without the scalpel provided by neurological disease.
Second, for practical purposes we can classify neurological

examples of disturbed central consciousness as follows:
A. Central consciousness disorder with preserved wakefulness

and minimal preserved attention and behavior. Prominent
examples are akinetic mutisms and epileptic automatisms.
Akinetic mutisms are caused by dysfunction of the cingulate
cortex, the basal forebrain, the thalamus, and the middle and
parietal pericingulate cortex.
B. Disorder of central consciousness with preserved wakefulness
but minimally defective attention and behavior. Absence
seizures and persistent vegetative state are prominent examples.
Absence seizures are related to dysfunction of the thalamus or
anterior cingulate cortex.
Persistent vegetative state, which is often confused with
coma, can be distinguished from coma in those vegetative
patients who have sleep-wake cycles, as evidenced by eye
blinking and sometimes their EEGs.
Persistent vegetative state is discussed in Chapter 8.
It is frequently caused by dysfunction of a specific set of structures
of the upper brain stem, the hypothalamus or the thalamus.
C. Disorder of central consciousness accompanied by

disturbance of wakefulness. Examples are coma, temporary
loss of consciousness caused by a head injury or fainting, deep
sleep (without dreams), and deep anesthesia. Significant aspects
of coma are discussed in Chapter 8, but I have already noted that
the characteristic locus of the disorder is in the structures of the
upper brainstem, hypothalamus, and thalamus. Control of sleep
and wakefulness lies in the same general region, and the action
of different anesthetics is also known to occur in that region.
Third, as will become clear when we discuss the neuroanatomical

correlates of consciousness (in Chapters 6 and 8), almost all sites of
brain damage associated with a significant disorder of central
consciousness share an important feature:
they are located near the midline of the brain; in fact, the left and right
sides of these structures are like mirror images facing each other
along that midline. In the brainstem and diencephalon area (the
region encompassing the thalamus and hypothalamus), the damaged
sites are close to the long array of canals and ventricles that define
the midline of the entire central nervous system. At the cortical level
they are located on the middle (inner) surface of the brain. None of
them can be seen when the lateral (external) aspects of the brain are
inspected, and they all occupy an intriguing 'central' position. These
structures are of an old evolutionary vintage, are present in numerous
non-human species, and mature early in individual human
development.
CHAPTER FOUR
THE HALF-HINTED HINT
LANGUAGE AND CONSCIOUSNESS
Being in medical school and majoring in neurology, I remember

repeatedly asking the wiser people around me how we produced the
conscious mind. It is curious that he always received the same
answer: it was made by language. I was told that creatures without
language were limited to their existence not known to them although
not us, the lucky human beings, because language was what made
us know. Consciousness was a verbal interpretation of existing mental
processes. Likewise, language provided us with the distance required
to see things in the right perspective. The answer seemed too easy,
too easy for something that even then I imagined intractably complex,
as well as implausible, given what I saw when I went to the zoo. I
never believed in such an answer and I'm glad I didn't.
Language, that is, words and sentences, is a translation of

something else, a conversion of nonlinguistic images that represent
entities, events, relationships, and inferences. If language serves
being and consciousness in the same way that it serves everything
else, that is, by symbolizing by words and phrases what previously
existed in a non-verbal form, then there must be some non-verbal
being and some non-verbal knowing. for which the word 'I' in the
phrase 'I know' are
suitable translations in any language. I think it is legitimate to take the phrase "I know"
to deduce from it the presence of a non-verbal image of knowing centered on a being
that precedes and motivates that verbalized phrase.
The idea that being and consciousness arise after language and are a direct
construction of language is not likely to be correct . Language does not come out of
nowhere. Language provides us with names for things. If being and consciousness
arose ex novo from language, they would be the only example of words without an
underlying concept.
Given our supreme gift of language, most of the ingredients of consciousness,

from objects to inferences, can be translated into language, and for us, at this point in
the history of nature and the history of each individual, the basic process of
consciousness is incessantly translated by language, covered by it if you prefer.
Language is a primary contributor to the higher form of consciousness that we are
using at this very moment and which I call expanded consciousness. Because of this,
it requires a great effort to imagine what is hidden behind the language, but it has to
be done.
If we had all that money:

Commentary on language and consciousness
As I studied case after case of patients with profound language disorders caused
by neurological diseases, I realized that regardless of the degree of language
impairment, the patient's mental processes remained essentially intact and, more
importantly, consciousness. of the patient in his situation seemed no different from
mine. Language's contribution to the mind was amazing to say the least, but its
contribution to central consciousness was nowhere to be found.
Which shouldn't be surprising when you consider where language

sits in the larger scheme of mental abilities. Is it plausible to believe
that linguistic utterances could be created in individuals who had no
sense of being, of the other, or of the environment?
In all the examples I know of, patients with significant language

impairments remain alert and alert and can behave in a purposeful
manner. More importantly, they are quite capable of indicating that
they are experiencing a certain object, or detecting the humor or
tragedy of a situation, or enacting to themselves an outcome that the
observer anticipates. These indications can be made through
impoverished language or through a gesture of the hand, a body
movement or a facial expression, but it appears there, immediately.
And just as importantly, emotion is present in abundance in the form
of background emotions, primary and secondary, and intricately
connected to ongoing events, evidently motivated by them, and
comparable, as can be recognized, to what our own emotions would
be in equivalent situations.
In this regard, the best evidence comes from patients with what
is known as global aphasia. This is a major failure of all language
faculties. Patients are unable to understand language, either audibly
or visually. In other words, they do not understand when they are
spoken to and cannot read a single word, not a single letter; they
have no ability to speak other than to utter stereotyped words, usually
curses; they don't even know how to repeat a word or a sound if
asked to do so. There is no evidence that words or phrases of any
kind are forming in his mind, awake and attentive. On the contrary,
everything indicates that his is a mental process without words.
And yet, just as it is out of the question to try to have a normal

conversation with a global aphasic, it is possible to communicate with
him, deeply, humanely, just by
have the patience to accommodate the limited and improvised

vocabulary of non-linguistic gestures that the patient may develop.
As we become familiar with the tools that are available to the patient,
it will never cross our minds to ask whether or not that human being
is conscious. As far as central consciousness is concerned, that
human being is no different from you or me, despite his inability to
translate thought into language or vice versa.
Now let me play devil's advocate and see where I'm going. In
patients with global aphasia, the damage destroys a large sector of
the left cerebral hemisphere, but it does not destroy it completely.
Patients with global aphasia present damage to the two famous
language areas, Broca's and Wernicke's, in the frontal and temporal
lobes of the left hemisphere; they usually have extensive damage in
the frontal, parietal, and temporal cortical regions between Broca's
and Wernicke's areas, and damage to a large amount of white matter
under these cortices and even gray matter in the basal ganglia of the
left hemisphere. Skeptics would argue, however, that even in the
worst cases of global aphasia there are still some parts of the left
hemisphere that remain intact in the prefrontal and occipital regions.
Could it be the case that such regions, even without being able to
allow normal speech, are capable of retaining some "language-
related" capacities that are necessary for "language-originated"
consciousness to emerge?
Figure 4.1. Minimal extent of damage to the left hemisphere of the brain in a
typical patient with global aphasia. Broca's and Wernicke's areas are destroyed,
as are other areas involved in cortical and subcortical language processing.
This possibility can be addressed directly by studying the behavior

of patients who have undergone radical removal of the entire left
hemisphere as a treatment for certain brain tumors. This operation,
which is no longer practiced but was once performed as a last resort
to treat the situation of patients with malignant brain tumors with a
very rapid and lethal course, required the complete removal of the
hemisphere within which the tumor was housed, that is, That is to say,
no cortex was left even in the areas that skeptics of my thought
experiment might invoke. As expected, left-sided hemispherectomies
were devastating from the language point of view, obtaining with them
the strongest type of global aphasia.
But I have a vivid image of some of those patients and I will relate the
case of a specific one, named Earl, who was studied in the mid-1960s
by Norman Geschwind.
I can assure you that there was no question at the time that Earl's
core consciousness was still intact, nor would it be today. Although
Earl's linguistic output was largely reduced to a few swearwords, it
was clear that he was using them quite intentionally to indicate what
he thought of the questions, the parts of the exam, and his frustratingly
limited abilities. Earl was not only alert and attentive, but also
developed a behavior appropriate to the miserable life that had been
his lot. They weren't mindless reflexes that he produced. He tried to
answer the questions put to him, sometimes using gestures, and there
were thoughtful pauses between trying to figure out what the hell the
investigator's pantomimes meant and coming to the conclusion that
he couldn't give him an answer. Sometimes I answered with a
movement
head or grimace. Sometimes the frustration showed in a revealing

gesture of the hand full of resignation. The melody of her emotions
was perfectly in tune with the moment she lived through.
Language hardly needs consciousness, one more of the important
capacities for which the human being should be grateful. The glories
of language lie elsewhere, in the ability to accurately translate thoughts
into words and phrases, and words and phrases into thoughts; in the
ability to quickly and cheaply classify knowledge under the protective
umbrella of a word; and in the ability to express imaginary constructions
or distant abstractions with a simple, perfectly effective word. But none
of these remarkable abilities (which have allowed the human mind to
grow in knowledge, intelligence, and creativity, and which have
enhanced those complex forms of expanded consciousness that we
enjoy today) have nothing to do with the production of central
consciousness, no more than they have to do with the production of
emotion or perception.
I always fondly remember a sweet granny whose attack had left

her with severe aphasia and who, with the will and intelligence her
conscious mind allowed, became determined to overcome her
shortcomings. She got a lot better, but her language was still a pale
shadow of what it was and not everyone signed up to hear her speak.
One day I was testing his ability to say names of individuals and I was
showing him a series of photographs of celebrities, asking him the
name of each one. We came to a glamorous photo of Nancy Reagan
(we were in the 1980s splurges) and there was Nancy Reagan
wrapped in a shiny silver thing, her hair gleaming; with a bright gaze
fixed on her husband Ronnie. My patient's charming, wrinkled face
darkened, and though she couldn't find Nancy Reagan's name, she
exclaimed, "If you had that much money, I 'd go like this, too." How
aware! He had instantly grasped the different layers of meaning in that
image.
iconic But although she had also been able to select some words correctly and had
even placed them in a correct conditional frame, she had not even been able to
consistently find the correct pronoun to indicate herself: the language could not give her
a stable translation for her being . or for any other. His language could no longer keep
up with the complexity of his thought process, and yet what a rich autobiographical
being he still had at his disposal.
MEMORY AND CONSCIOUSNESS
Just as language can be exonerated from any responsibility in the creation of

central consciousness, so can conventional memory. Central consciousness is not
based on extensive memory. It is also not based on working memory, which, however,
is necessary for expanded consciousness. As far as memory is concerned, the only
thing central consciousness requires is a very brief, short-term memory. We do not need
access to vast repositories of personal memories to have central consciousness,
although these vast autobiographical repositories contribute to those advanced degrees
of consciousness that I have called expanded consciousness. My views on this matter
have been shaped by researching patients with severe learning and memory disorders,
the so-called amnesias. I will illustrate what I think with the case of a patient of mine,
David, surely the most profoundly amnesic patient studied and whom I have been
studying for more than twenty years. I spoke of him when I offered the results of the
"good guy, bad guy" experiment, and here he is, now, in person.
nothing comes to mind

My friend David just arrived. I greet him with a hug and a smile and he
returns the gesture. I am delighted to see him and he is delighted to see me.
Everything is so natural that I can't tell who smiled first or who took the first
step towards the other. No matter. David and I are delighted to be here. We
sat down and started chatting like two old friends. I offer him a coffee and I
also help myself to another. If you saw us from the other side of the window,
there would be nothing that would catch your attention.
But the scene is about to change. Breaking the convention of pleasant

conversations between friends, I turn to David and ask him who I am. Not
fazed, David says I'm his friend. Without being taken aback, I say, “Naturally.
But David: who am I really, what is my name?
“Oh, I don't know. I don't remember now, I can't remember.

"But David, please try to remember my name."
And then David answers.
“You are my cousin George.
"George what, David?" Cousin George what?
"My cousin George McKenzie," says David, in a voice
affirmative but with a fleeting and strange frown.
Everyone knows I'm not George McKenzie and I'm not David's cousin:
everyone except David, obviously.
Although it seems otherwise, David does not know who I am. He doesn't know
what I do for a living, he doesn't know if he's seen me before or not, he doesn't
know the last time he saw me, and he doesn't know my name. Nor does he
know the name of the city in which he is located, nor the name of the street,
nor the name of the building. He doesn't know what time it is either, although
when I ask him what time it is he immediately looks at his watch and says,
correctly, that it's a quarter to three. When I ask him the date, he looks at his
watch again and says, not wrong either, that it is the sixth.
It has a clock with a big window for the day of the month but not for the month.
“Perfect David, perfect. But what month, please?

To which he replies, glancing uneasily down the
room and seeing the curtains closed in the room:
—Well, February or March, I think; It has been quite cold. And
without wasting a second, in the middle of the last sentence, he gets
up, goes to the window, draws back the curtains and exclaims: "Oh,
no, gosh." We must be in June or July, the weather is quite summery.
"Certainly," I tell him. It's June and it's thirty-two degrees.
To which David replies,

"Thirty-two degrees above zero?" Wow, that's great, we should
go out.
David returns to his seat and we continue the conversation. If we
leave aside specific questions of people, places, events or dates, the
conversation returns to normal. David knows how to live in a world
without concreteness. Choose your words well; speak melodiously;
he has a prosody rich in intonations appropriate to each moment, and
his facial expressions, his hand and arm gestures, as well as the body
posture he adopts when relaxing in the chair are precisely what we
might expect in that situation. David's underlying emotions flow like a
wide and mighty river. But the spontaneous content of David's
conversations is generic, and as soon as he is asked to give any non-
generic detail, he often refuses, quite naively confessing that nothing
comes to mind. If pressed for a specific description of an event or to
place it in time, or to give the name of a specific person, he will drop
his precautions and make up a story.
My old friend David has one of the most profound memory lesions
ever recorded in a human being. David's memory was completely
normal until the day he fell ill with severe encephalitis. In David's
case, this disease
infection of brain tissue was caused by a virus, type I herpes simplex

virus. Most of us carry the virus but only a very small number of us
will get encephalitis caused by it. No one knows why the virus
suddenly becomes aggressive in those unlucky few.
David was forty-six years old when he had encephalitis. The

disease caused significant deterioration in certain regions of David's
brain, namely the left and right temporal lobes. Once the infectious
process was over, and in a matter of weeks, it became clear that
David was incapable of learning any new facts. I just couldn't
memorize anything new. It didn't matter whether it was a new person
or a new landscape, whether he saw a new event or was asked to
remember a word, he retained nothing in his memory. His memory
was limited to a time window of less than a minute. During that brief
period his memory for new events was normal. If I showed up and
introduced myself to him, he would leave the room and come back
after, say twenty seconds, to ask who I was, he would immediately
tell me my name and say yes, we had just met, that I had left and just
got back. But if I came back in three minutes instead, David hadn't
the faintest idea who I was. And if I pressed him, I could turn into
anyone, maybe his cousin Georges McKenzie.
In his profound inability to learn new facts, David resembled

patient HM, first studied in detail by psychologist Brenda Milner. HM
has been unable to memorize any new facts since the mid-1950s
(curiously, he's close in age to David). But David's memory defect is
broader than HM's because not only is he unable to memorize new
facts, but he is also unable to remember many old facts. He is denied
the
recollection of virtually any singular thing, individual, or event in your life.

His memory loss goes back almost to the
cradle.
In this devastation there are a few exceptions. He knows his name
and those of his wife, children and close relatives. He doesn't remember
what each of them looks like or what their voices sound like. Nor, equally,
can he recognize them in photographs, neither old nor recent, nor does
he recognize them in person. The truth is that he does not even recognize
himself in the photos, except for some photos of him as a young man.
The reason that David and HM are so similar in their inability to memorize
new facts and so different in their ability to remember old facts is that they
share the location of one lesion, in the hippocampus, but not another that
occurs only in David: in the cortices of the rest of the temporal lobe,
especially those of the polar and inferotemporal regions.
David knows his previous professional occupation and the name of

the city where he has spent most of his life, but he cannot visualize the
place and cannot recognize photos of his previous houses, the cars he
has owned, the pets you wanted or personal artifacts you cherished.
Nothing comes to mind when asked about those particular objects, and
what comes to mind when shown pictures of those objects, or the objects
themselves, is knowledge of that object as a member of a conceptual
category. . If he is shown a picture of his fourteen-year-old son, he says
that it is a young man with a nice smile and that he is probably going to
high school, but he has no idea that it is his own son. The only thing he
remembers, as the previous conversation reveals, is generalities about
almost everything in the world around him. He knows what a city, a street
and a building is, and how a hospital differs from a hotel. You know what
types of furniture, clothing, or means of transportation are available. He
also knows how different things objects or living beings can do and in
general he knows the general development of the events that suppose
the presence of those objects or
living beings. But when one realizes that one has lost the possibility
of access to the singular facts that one learned up to the age of forty-
six, and that, since then, one has not been able to apprehend new
facts, one realizes the magnitude of the its deterioration. His
deterioration is so profound that we may well wonder what is the mind
of such a person. Is David a zombie, that kind of being that some
philosophers have created in their thought experiments? Or to go to
what matters to us now: is David aware?
David's conscience
David fits perfectly well on the core consciousness checklist. For

starters, David is awake. In the traditional jargon of neurologists, it is
"awake and oriented." By the way, we know that his circadian rhythms
are normal, that he sleeps normally, and that he spends as much of
his sleep as might be expected in REM sleep, the rapid eye
movement* period during which we dream. There is also no harm in
admitting that David pays attention to the stimuli that are presented
to him. Whether he is asked to listen to a phrase or a piece of music,
or shown a picture or a movie, he attends to the stimulus as you or I
do, sometimes with great enthusiasm, other times with less, but
always adequate enough as to process the stimulus, create an
impression of it and be ready to answer the question that is asked
about it. You can focus and sustain attention for substantial periods
of time, long indeed, whenever the stimulus or situation arouses your
interest. You can play, for example, and win! a complete game of
checkers even though he doesn't even know the name of the game
and wouldn't be able to say a single one of its rules or when was the
last time he played a game. Background emotions come in a
continuous flow, as do many, but not all, primary and secondary
emotions. His joy when he wins
it is delicious to see; the affective modulation of his voice as the

game approaches its decisive moment is a caton of human emotion.
Finally, his goal-oriented behavior is deliberate: he will seek, for
example, a comfortable chair in which to sit, food and drink, a
television screen, or a window through which to observe the world. If
left to their own devices, they engage in deliberate behavior in relation
to the context in which they find themselves, even for many minutes
or hours, as long as what they are doing is interesting to them.
The difference between David and the patients I have described

above is quite clear. Patients with automatism epilepticus are also
awake, but their attention span is extremely short when not resting
on an object, and then only long enough to create an image and
provoke subsequent action. The behavior of patients with automatism
is deliberate only within each action (drinking from a glass) or for a
few consecutive actions (getting up and walking) but they do not
present a continuity of purpose. Their behaviors are not appropriate
in the general context of a situation.
On the basis that wakefulness, attention, and deliberate behavior

are normal and present, those using an external definition of
consciousness would conclude that David has normal consciousness.
I would, of course, agree, and in order to help diagnose externalists I
would add that David is quite aware of the relationship between
himself and his environment, as the report of personal reactions to
things and events that surround him clearly indicates. surround. I
can't jump into his mind to take a look, but I can parse his ubiquitous
comments about the world he experiences: "Wow, great!", "I like this
one," "Nice to be here looking at pictures with you." », «Geez, how
horrible», «I find this flavor delicious, it's the one I like the most», «I
think it's not right to say those things in public». It is legitimate to
deduce
that since we are organisms of the same species and that since their
comments are not formally different from those that the rest of us
would make in similar circumstances, they originate in a state of mind
formally comparable with the one that we would have when making
such judgments. When almost nothing comes to mind, David
continues to have his sense of being.
Within the time window of your short-term memory (which lasts
about forty-five seconds) you have plenty of time to generate central
awareness about a lot of things. We have evidence that the images
David forms in the various sensory modalities (vision, hearing, touch)
are formed from the perspective of his organism. It is absolutely clear
that he treats them as his own images and not someone else's. And
it is readily observable that he can act on these images and offer
acting intentions that are closely matched to the content of those
images. In short, David is not a zombie. As far as core consciousness
is concerned, David is just as conscious as you or me.
It goes without saying that David's mind is not quite the same as
yours or mine to describe what is missing. It is like ours in that it has
varied sensory modalities, that these images occur in coordinated
and logically interconnected sets, that these sets change over time in
a forward direction, and that old sets are succeeded by new ones.
new. David has a stream of such ensembles, of the kind of processes
that Shakespeare and Joyce turned into literary form in their soliloquies
and that William James called stream of consciousness (or stream
of consciousness). But the content of David's stream-of-
consciousness images is another matter entirely. We know for sure
that his images encompass the general rather than the particular:
general knowledge about the stimuli we show him and general
knowledge about him, about his body, about his current physical and
mental states, about his tastes
and aversions. Unlike us, David can never evoke the specifics of
singular things, people, places, or events. While you and I inevitably
mix images of general knowledge with images of singular knowledge
at every turn, David is forced into the confinement of the general.
David's mind differs from ours in the specificity of its contents. I
suspect that it also differs in the number of images. Being limited to
generic content, David's mind surely processes fewer images in each
unit of time than you or I do.
The mere lack of specific content puts at risk their ability to relate
the apprehension of a certain object with the comprehensive scope
of its historical person. He can notice the factual meaning of an object
and develop a feeling of pleasure from that object, but he cannot
tease out how he has developed the factual meaning and feeling, nor
can he recall what specific examples in his autobiography may have
led to those images that evokes. Nor can it unravel how this or that
object is related (or not) to its possible future, for the simple reason
that David has no memory of a planned potential future like you and
I do. David has not been able to plan ahead because that planning
requires the intelligent manipulation of specific images from the past
and David cannot conjure up any specific images. Everything
indicates that he has a normal sense of being in the here and now,
but his autobiographical memory has been reduced to the skeleton
and therefore the autobiographical being that he can build at each
moment is tremendously impoverished.
As a result of this narrowness of specificity, David has an

impaired extended consciousness. It is possible that if he were able
to evoke the specific contents that he no longer possesses in his
autobiographical memory, some of the mechanisms that allow for
expanded consciousness would be in place. There is no evidence
that it lacks the ability to produce various images
simultaneous mental responses or to hold in mind different images

from different sensory modalities, a capability that enables working
memory and is essential for expanded consciousness. For example,
you can perform tasks that require combinations of colors, shapes,
and sizes without difficulty.
Figure 4.2. The extent of damage to patient David's temporal lobe. The injury
destroyed large sections of the temporal lobes, including the hippocampus,
in both the left and right hemispheres. Memorization of new facts and recall of old
facts are severely impaired.
Because David lacks the specificities required to define unique

terms, he also lacks the aspects of expanded consciousness related
to social learning and behavior. Higher awareness of social situations
is built on vast knowledge of specific social situations, and David
cannot evoke such knowledge. He respects a number of social
conventions, as evidenced by the polite manners he uses when
greeting others, intervening in conversations, or walking down a
street or hallway. Also
has notions of what is a humane and kind behavior.

But comprehensive knowledge of the operations of the social collectivity
eludes him.
David provides evidence that supports both of these conclusions.
The first is that factual knowledge to a singular and specific degree is
not a prerequisite for central consciousness. The second: David has
extensive damage to both temporal regions, including the hippocampus,
the medial cortices that cover it, the polar temporal region, a large
section of the lateral and inferior temporal regions, and the amygdala.
Thus we know that central consciousness does not depend on these
large brain regions at all.
SOME FACTS, CORNERED
From this brief survey of the conditions under which consciousness

may be impaired or intact, a number of preliminary facts can be
gleaned.
First, consciousness is not a monolith. It is reasonable to
distinguish types of consciousness (there is at least a natural separation
between the simple and basic type and the complex and extended
type) and it is also reasonable to distinguish levels or degrees within
the extended consciousness. The basic type of consciousness, central
consciousness, is impaired in akinetic mutism, in absence seizures
and epileptic automatisms, in persistent vegetative state, in coma, in
deep (dreamless) sleep, and during sleep. deep anesthesia. Given the
basic character of the central consciousness, when it fails, the
extended consciousness also fails. On the other hand, when extended
consciousness is impaired, as exemplified in patients with profound
autobiographical memory disorders, central consciousness remains
intact. (Amplified consciousness and its disorders are discussed in
Chapter 7.)
Second, it is possible to separate consciousness in general from

other functions such as wakefulness, low-intensity attention, working
memory, conventional memory, language, and reasoning.
Central awareness is not the same as wakefulness or low-intensity
attention, although it requires both to function normally.
As we have seen, patients with absence seizures or akinetic mutism
are technically awake but not conscious. On the other hand, patients
who lose wakefulness (leaving aside the partial exception of REM
sleep) may no longer be conscious.
Having central awareness is not the same as holding an image

over time, a process known as working memory: the feeling of being
and knowing is so brief and occurs in such abundance that you don't
have to hold it for a while to be effective . On the other hand, working
memory is vital to the process of expanded consciousness.
As we have seen, central consciousness does not depend on

the construction of a stable memory of an image or on remembering
it itself, that is, it does not depend on conventional learning and
memorization processes; the central consciousness is not based on
language; Finally, central awareness is not the same as intelligently
manipulating an image in processes such as planning, problem
solving, and creativity. Patients with profound defects in reasoning
and planning show a perfectly normal central consciousness, although
in such cases the higher reaches of extended consciousness are
defective. (See Descartes' Error.)
All these different aspects of cognition (waking, imagery,

attention, working memory, conventional memory, language,
intelligence) can be separated by proper analysis and investigated
separately despite the fact that they work together, in perfect accord
with the conscience, as a very harmonious and virtuous whole.
Third, emotion and core consciousness are clearly associated.

Patients who have impaired central awareness do not reveal emotion
through facial expression, body expression, or vocalization. The full
range of emotions, from background to secondary emotions, is often
absent in these patients . the expanded consciousness present normal
background and primary emotions. This association seems to indicate,
at the very least, that some of the neural devices on which emotion
and central consciousness depend are located in the same region.
However, it is also plausible that the connection between emotion and
central consciousness goes beyond a mere contiguity of the neural
devices on which they depend.
Fourth, disturbances of central consciousness target the entire

realm of mental activity, as well as the full range of sensory modalities.
In patients with disturbed central consciousness, from those in a coma
or persistent vegetative state to those with automatic epilepticus,
akinetic mutism, and absence seizures, impaired central consciousness
leaves no island of preserved consciousness. The impairment extends
to all sensory modalities. The central consciousness serves the whole
range of thoughts that can be made conscious, the whole range of
things that can be known. Core consciousness is a nuclear resource.
On the other hand, and as will be seen in the following chapter,

the deterioration of the construction of images in each sensory
modality, for example visual or auditory, only jeopardizes the conscious
appreciation of one aspect of an object (visual or auditory). , but not
central awareness in general and not even awareness of that same
object via a different sensory channel, for example
olfactory or tactile. Naturally, a deterioration of all image-building

capacity completely eliminates consciousness, because consciousness
works with images.
The above observations are not compatible with the idea that
consciousness is interrupted in the sensory sector. There are diseases
in which brain damage prevents patients from processing images of
a certain type, auditory or visual, for example.
In such cases, almost complete sensory processing in the
corresponding modality may be lost, as occurs in cortical blindness;
or a single aspect of that modality may be lost, as occurs in the loss
of color processing called achromatopsia; or a substantial part of the
process may be interrupted, as when patients are unable to recognize
familiar faces in the condition called prosopagnosia. Within my
explanatory scheme, patients thus affected exhibit a "what-to-know"
disturbance. But they have normal central awareness for all the
images formed in the other sensory modalities, and just as importantly,
they have normal central awareness for specific stimuli that they
cannot process normally. In other words, patients who cannot
recognize a familiar face have normal central awareness for the
stimulus presented to them and are perfectly aware that they do not
know that face even though they should. In fact, they know that it is a
human face and that what fails them is their sense of being in the act
of knowing. Those patients have normal central consciousness and
normal expanded consciousness outside of that island of faulty
awareness. The constrained predicament in which they find
themselves underscores the fact that core consciousness, and its
resulting sense of self, is a core resource. These observations also
challenge attempts to understand consciousness holistically within
the domain of a single sensory modality, such as vision, without
resorting to the notion of the whole organism that consciousness
serves. These attempts can contribute to the
elucidation of the first of the two problems of consciousness outlined

in chapter 1 (the problem of the movie on the brain) but they do not
address problem number two, the problem of the sense of being in
the act of knowing.2
The fact that central consciousness is separable from other
cognitive processes does not mean that consciousness does not
influence them. On the contrary, and as explained in chapter 6, the
central consciousness has a major influence on these other cognitive
processes. Central awareness focuses and enhances attention and
cognitive memory; the central consciousness favors the settlement of
memories; the central consciousness is indispensable for the normal
operations of language; and central awareness enlarges the field of
intelligent manipulations that we call planning, problem solving, and
creativity.
In conclusion, being individuals as we are, provided with

extensive memory and intelligence, we can manipulate facts logically
without the help of language and make inferences from those facts.
But my point is that core consciousness can be distinguished from
the inferences we can make about the content of core consciousness.
We can infer that the thoughts in our minds are created in our
individual perspective; that belong to us; that we can act on them;
that the apparent protagonist of the relationship with the object is our
organism. As I see it, however, central awareness begins before such
inferences: it is the evidence itself, the undisguised sensation of
our individual organism in the act of knowing.
All of the cognitive properties discussed above have been

enhanced by core awareness and, in turn, have helped build
expanded awareness on the foundation of core awareness. However,
the umbilical cord has never been cut. Behind the expanded
consciousness, moment after moment,
the pulse of central consciousness is felt. This may be surprising, but

it shouldn't be. We still need to digest before we can enjoy Bach.
THE HALF-HINTED HINT
It is time to say a bit more about central consciousness, now that

we have examined the circumstances in which it may either disappear
or be conspicuously preserved, despite other important cognitive
disturbances.
In the opening chapter of this book I suggested that central
consciousness comprises an inner sensation based on images.
I also suggested that these concrete images are those of sensation.
That inner feeling carries a powerful non-verbal message that has to
do with the relationship between organism and object: that there is
an individual subject in that relationship, a temporarily constructed
entity to which the knowledge of that moment is apparently attributed.
Implicit in the message is the idea that the images that are being
processed of a given object are formed with our individual perspective,
that we are the owners of such a thought process and that we can
act on the contents of that thought process. The final end of the
central consciousness process involves the enhancement of the
object that initiated it, so that the object stands out as part of its
relationship to the knowing organism.
The view of consciousness that I take here connects historically

with that expressed by thinkers as diverse as Locke, Brentano, Kant,
Freud, and William James. They all thought, as I did, that
consciousness is an "inner feeling." It is curious that this "inner
feeling" view is no longer the main one in consciousness studies.3 In
the view I take here, consciousness
it also conforms to the fundamental properties that William James

attributed to it: it is selective, continuous, it relates to objects other
than itself, it is personal. James did not distinguish between central
consciousness and varieties of extended consciousness, but this is
not a problem because the properties he proposed apply easily to
both kinds of consciousness.4
The central consciousness originates as pulsations for each of
the contents of which we are aware.
When we face an object, we build a neural pattern of it and
automatically discover that the now outstanding image of the object is
formed in our perspective, belongs to us and we can even modify it,
what materializes is knowledge. And we arrive at this knowledge, this
discovery as I prefer to call it, instantly: there is no process of inference
that can be felt, nor is there a logical process with light and
stenographers, nor are there words: what is it is the image of the
object and, immediately afterwards, our feeling that this image is ours.
What we will never know directly is the mechanism behind that

discovery, the steps that have to be taken behind the apparently
exposed stage of our mind for the central consciousness of an object's
image to emerge and become our own. As a whole, the steps that are
taken behind the scenes take time, since time is the essence that
establishes the causal link between the image of an object and its
possession by us. The elapsed time is minuscule if we measure it
with a good stopwatch, but it is certainly quite considerable if we think
about it from the perspective of the neurons that make this knowledge
possible and whose units of time are much smaller than those of our
conscious mind: the neurons are they excite and fire in a few
milliseconds, while the events we are aware of occur in orders of
many tens, hundreds, and thousands of milliseconds. By the time the
consciousness of a
given object, things already carry within the machinery of our brain
what would be an eternity for a molecule... if molecules could think.
We always arrive hopelessly late to consciousness and since we all
suffer from such a delay, nobody notices it. The idea that
consciousness is delayed in relation to the entity that initiates the
process of consciousness is supported by Benjamin Libet's novel
experiments on the time it takes for a stimulus to become conscious.
We arrive at consciousness with a delay of probably about five
hundred milliseconds.5 Of course, it is curious that we can place our
mental being between cellular time, on the one hand, and the time
that evolution has taken to leave us where we are, on the other. , and
also humiliating, without a doubt, that we cannot adequately imagine
any of those time scales so far away from us.
When you look at this page and read these words, whether you
like it or not, incessantly and automatically, you feel that you are
reading. It's not me, or anyone else. Are you. You feel that the objects
you perceive at this moment (the book, the room around you, the
street beyond the window) are apprehended by you from your
perspective and that the thoughts that form in your mind are precisely
yours and no one's. plus. You also feel that you can act on such a
scene if you wish: stop reading, start reflecting, get up and go for a
walk. Consciousness is the umbrella term that encompasses the
mental phenomena that allow for that strange situation of you as an
observer or knower of the things observed, of you as the possessor
of the thoughts that form in your perspective, of you as a potential
agent of that scene. Consciousness is part of your thought process
and is not external to it. The individual perspective, the individual
property of a thought and being an individual agent are the
fundamental contributions with which the central consciousness
contributes to the mental process that is now taking place in your
organism. The essence of the central consciousness consists of the
thinking of yourself, in feeling yourself, as an individual being involved

in the process of knowing your own existence and the existence of
others. Let us not worry for the moment about knowing and being,
which are real mental entities, turning out to be, from a biological
point of view, perfectly real but quite different from what our intuitions
might lead us to think.
As you go along, you are reading this text and translating the
meaning of its words into a stream of thought. The words and phrases
on the page, which are translations of my concepts, are themselves
translated into non-verbal images in your reader's mind. The collection
of those images defines the concepts that were originally in my mind.
But parallel to this perception of printed words and the display of

corresponding conceptual knowledge required to understand them,
your mind also pictures yourself reading and understanding, moment
after moment. The entire scope of your mind is not confined to images
of what is perceived externally or what is remembered in relation to
what is perceived. It covers you too.
The images that constitute knowing and the sensation of being

(the sensations of knowing) do not rule over his mind. They influence
the mind in a very powerful way and yet they usually remain in the
shadows; they are discreet. The most frequent thing is that knowing
and feeling the being are manifested in a subtle way rather than
assertively. The fate of the subtle mental contents is to be overlooked,
and not only those that constitute knowing and being.
Think about the task you are doing right now: the words on the
page and the thoughts they give rise to require, according to traditional
psychology, a procedure called attention, a kind of finite commodity if
we consider it in terms of real-time mental processing. My words and
your thoughts dominate almost all the processing capacity that you
have at your disposal.
provision. In all probability, you are not simultaneously attentive to all

the images that you are evoking as you analyze this text, much less
attentive to other images that you are also currently evoking that are
unrelated to the text. As a result, some of your thoughts will gain
prominence while others recede into the background of your mind: for
example, the words on the page may blur or disappear entirely for a
few moments if you stop to think about other images on the page.
your thought process.
Discretion and subtlety are thus directed at you as the discriminating

individual; and not just because: but because for the mind they are
the normal way of functioning.
A large number of the images that are formed on any subject go
unnoticed or barely noticed at some point. A few minutes ago the
following happened: I was walking up to my study with a book in my
left hand and a cup of coffee in my right. Earlier, halfway up the climb,
he had left two feathers on a step. Walking up the stairs, unaware
that I had any thoughts on this matter, I quickly and smoothly
transferred the cup to my left hand, a skillful action that required a
precise movement to avoid spilling the coffee and also involved place
the book under the left arm; It was then that I proceeded to pick up
the feathers with my right hand. In retrospect, all these actions that
are not usual in that place and in that order, were happening
seamlessly and, apparently, without thinking. In fact, the only thing I
realized was that there was some "plan" behind all these actions
when I saw how my right hand had taken the shape necessary to hold
the two pens given their spatial orientation.
For a split second, by focusing my attention on what had just

happened instead of continuing to attend to the moment itself, I was
able to reconstruct a part of the sensorimotor process that lay behind
this trivial yet complex event.
Only a fraction of what goes on in the mind is clear enough for

us to notice, and yet it is there, close by, and even available to us if
we try. The funny thing is that personal context influences how much
or how little one perceives at the edge of the mind. Had I not been
preoccupied with the matter of the subtle presence of the central
being, I probably would not have been aware of this incident at all
and would not have reflected on the wealth of mental detail that
accompanied these remarkable acts . surprised in the act of knowing,
I would tell him: pay more attention and you'll see. I would also say
that it is an advantage not to realize that one knows. If we think
about it, unless the specific purpose of the mental moment was to
reflect a state of our organism, it would make little sense to focus our
attention on the part of the mental content that constitutes the self of
the moment: there is no need to waste processing capacity in
ourselves nothing else. Let's be, without more.
The fact that the we that he designates can use discretion does
not mean that this discriminator is unimportant or expendable. To a
certain extent, we can voluntarily control the activity of the most
complex sense of our being, which I call the autobiographical being;
we can allow it to dominate the landscape of our mind or to minimize
it.
But there is little we can do about the presence of our core being; we
can't make it vanish completely: there's always a substantial presence
left, and thank goodness it is.
As we have already seen, the disappearance of the central
consciousness, except in those situations in which it disappears due
to sleep or anesthesia, is a symptom of disease. If the disappearance
is only partial, it gives rise to an abnormal state that others will easily
recognize as abnormal but of which we ourselves will not know: when
there is no knowing, we do not know. The important thing is that the
disappearance of knowing and being without the disappearance of
wakefulness places the organism in a serious situation of danger: we are
able to act without knowing the consequences of our actions.

It is as if, lacking the sensation of being in the act of knowing, the
thoughts we generate had no owner, since the owner that corresponds
to them in their own right has disappeared. The organism that remains
impoverished without being is lost by not knowing to whom those
thoughts belong.
THIRD PART
A BIOLOGY TO KNOW
CHAPTER FIVE
THE ORGANISM AND THE OBJECT
THE BODY BEHIND THE BEING
Focusing research on consciousness on the problems of being

made it very interesting but not clearer until I began to see
consciousness in terms of two actors, the organism and the object,
and in terms of the relationships maintained by these two actors.
Suddenly, consciousness came to consist of forming knowledge
about two facts: the fact that the organism is involved in a relationship
with a certain object, and the fact that the object of that relationship
causes a change in the organism. As previously indicated, elucidating
the biology of consciousness became discovering how the brain can
form neural patterns that represent each of the two actors and the
relationships between them.
The problem of representing the object seems less enigmatic

than that of representing the organism. Neuroscience has devoted
considerable effort to understanding the neural basis of object
representation. Extensive studies of perception, learning, and
memory, as well as language, have given us a workable idea of how
the brain processes an object in sensory and motor terms, and some
idea of how it can be stored in memory, categorized in terms
conceptual or linguistic and retrieve knowledge about a particular
object by way of memory or recognition. The object is presented to
the appropriate sensory cortices to
its nature, in the form of neural patterns. For example, in the case of the visual aspects
of an object, the appropriate neural patterns are formed in a variety of regions of the
visual cortices, not one or two but many, that work in concert to represent the various
aspects of the object in question. when it comes to your display. Later in this chapter we
will return to the representation of the object.
However, on the part of the organism things are different.

Although much has been learned about how the organism is represented in the brain,
the idea that these representations might be linked to the mind and the notion of being
has received little attention. The question remains unanswered as to what it is that could
give the brain a natural means of generating that singular and stable reference that we
call being. I have long believed that the answer lies in a particular set of representations
of the organism and its potential actions. In Descartes's Error I advanced the possibility
that the part of the mind that we call being was based, biologically speaking, on a
collection of non-conscious neural patterns that represented the part of the organism
that we call the body proper . It may sound terribly strange when you first hear it, but it
may seem more plausible after you consider the reasons I'm about to offer.
The need for stability
In thinking about the biological roots of the self's evolution from the simple central
self to the complex autobiographical self, I began by considering their common
characteristics. I placed stability at the top of the list, and here's why. In all the types of
being that we can consider there is always a notion that dominates center stage: the
notion of a limited, singular individual, who is always changing slightly

with the passage of time but who, we do not know how, seems to
remain the same. By emphasizing stability, I do not mean to imply
that the self, in any of its versions, is an immutable cognitive or neural
entity, but rather that it possesses a remarkable degree of structural
invariance, such that it can provide a continuity of reference
throughout. of long periods of time. Indeed, what is needed is for the
being to offer a continuity of reference.
For all areas of processing, from the simplest to the most

complex, relative stability is required. Stability must be present when
we relate to various objects in space or to react with emotional
coherence in a certain way in certain situations. Stability is also found
in the realm of complex ideas.
When I say "I've changed my mind about multinationals," I mean that

I once held certain views about multinationals, views that I no longer
hold. The contents that describe multinationals today and their current
behavior have changed in my mind, but my “being” has not changed,
or at least not to the same extent as my ideas about multinationals.
Relative stability provides a continuity of reference and is therefore a
requirement for being.
Our search for a biological substrate of being must identify structures

capable of providing such stability.
Delving into the notion of being, we discover the notion of the
singular individual. By delving into individual uniqueness we discover
stability. The riddle of the biological roots of being can then be
formulated as follows: what is the backbone of the mind, is it unique
and the same?
The internal environment as a precursor to being

Consciousness is an important property of living organisms, and

it may be useful to introduce life into the discussion of consciousness.
Certainly consciousness appears as a postscript to life and to the
basic devices that allow organisms to sustain life, and in all probability
consciousness has succeeded in evolution precisely because it
supports life in the best possible way.
A key to understanding living organisms, from those with a single
cell to those made up of billions of cells, is the definition of their
boundaries, the separation of what is inside and what is outside. The
structure of the organism is internal to the limits and the life of the
organism is defined by the maintenance of internal states within those
limits. Singular individuality depends on limits.
No matter what happens, even when there are great variations in

the environment surrounding the organism, there is an organization in
the structure of the organism that modifies the internal functioning of
the organism. This organization ensures that environmental variations
do not cause an equally wide and excessive variation of internal
activities. When boundary-crossing variations to a dangerous level are
about to occur, they can be circumvented by some priority action; and
when those dangerous variations have already occurred, they can be
corrected by appropriate action.
The survival requirements that I describe here comprise a limit,

an internal structure, an organization for the regulation of internal
states that in turn includes a mandate to maintain life, and a narrow
margin of variability of internal states, such that those states are
relatively stable.
Let us now think about such requirements. Am I just describing a list
of requirements for the survival of a single living organism, or could it
be that I am also describing some of the biological antecedents of the
sense of being, the sense of a single, limited living organism dedicated
to maintaining its stability for life? stay alive? i would say i could be
describing either of them. It is enigmatic to think that the constancy of

the inner environment is essential to sustain life and that it could also
be an initial project and an anchor for what will later end up being the
being of the mind.
More about the internal environment
A simple organism composed of a single cell, such as an amoeba,

is not only alive but is dedicated to staying alive. Being a brainless
and mindless creature, the amoeba does not know the intentions of
its own organism in the sense that we know the intentions of ours.
But with everything, in it is found the form of an intention expressed

in the way that this little creature manages to keep the chemical profile
of its internal environment in balance while around it, in the
environment external to it, they can be unleashing the wrath of hell.
What I want to get at is that the need to be alive is not a recent

thing. It is not an exclusive property of human beings. In one way or
another, most living beings present it, from the simple to the complex.
What varies is the degree to which agencies are aware of such a
need. Few know her. But that need is still there, whether or not the
organizations know about it. Thanks to consciousness, we humans
are deeply aware of it.
Life takes place inside a border that defines a body. Life and the
need for life occur within a border, a selectively permeable wall that
separates the internal from the external environment. The idea of
organism has its center in the existence of that border. In the individual
cell, the border is called the membrane. In complex creatures like us
it takes many forms: for example, the skin that covers most of our
bodies; the cornea that covers the part of the eyeball
that lets in light; the mucous membranes that cover the mouth. If there is no border
there is no body and if there is no body there is no organism. Life needs limits. I believe
that minds and consciousnesses, once they appeared in evolution, were first and
foremost a matter of life and the necessity of life within a certain border. And to a large
extent they still are.
under the microscope
Let's now take a look at the boundary of a single cell.

We will discover the nucleus of the cell submerged in a dense bath called cytoplasm.
Within the cytoplasm are also the organelles, sub-departments of the cell, such as the
mitochondria and microtubules. Life is only maintained if the chemical profile of the
bath is kept within certain margins of possible variation. Life is interrupted when the
variation of a set of chemical parameters exceeds or does not reach certain values.
The curious thing is that life consists of continuous variation, but only if the range of
variation is constrained within certain limits. If we stopped to look closely inside the
border, we would see that life consists of one great change after another, in a rough
sea in which one huge wave is followed by another. But when viewed from afar, the
changes are tempered, as when a churning ocean becomes a smooth glassy surface
seen from an airplane. And if we step back even further and look simultaneously at the
entire cell and at its environment, we will see that in the face of the upheavals of its
environment, life inside the cell becomes above all stability and sameness.
The task of restraining the amplitude of the changes, of keeping the interior in
check against the alterations of the exterior, is an enormous task. It is carried out
incessantly, made up of very precisely directed commands and control functions that
are distributed
throughout the nucleus, organelles, and cytoplasm of the cell. In

1865 Claude Bernard, a French biologist, named the internal
environment of an organism: the internal milieu. The term has
lived on with its Gallic flavor, and it does not occur to anyone to
use "internal environment" as a possible translation.* Claude
Bernard pointed out that the chemical profile of the fluid in which
cells live is usually quite stable, varying only within narrow
margins, no matter how great the changes in the environment
surrounding the organism. His insight was that for independent
life to continue, the internal environment must be stable. During
the early 20th century, WB Cannon would carry these ideas
forward by writing about a biological function he called
homeostasis , which he described as "the coordinated
physiological reactions that maintain most stable states of the
body...and which are so characteristic of the living organism.”2
The involuntary and unconscious need to stay alive betrays itself
inside a single cell by means of a complicated operation that
requires “noticing” the state of the chemical profile inside the
border and that it requires an involuntary "unconscious
knowledge" of what to do, chemically speaking, when that
noticing indicates excess or deficiency of some particular
ingredient at some point in the cell, or at a certain time. To put it
another way: it requires something that is not very different from
perception in order to notice the imbalance; it requires something
not unlike implicit memory, in the form of dispositions for action,
in order to exercise its technical possibilities; and it also requires
something that is not too different from the ability to take
preventive or corrective action. If all of this sounds like a
description of important functions of your own brain, you're right.
However, the truth is that I am not talking about the brain,
because there is no nervous system inside that cellulite. What's
more, this brain-like mechanism that isn't really a brain can't be
the
result of nature copying the properties of the brain.

On the contrary, noticing the environmental conditions and having the
different possibilities of action, in addition to acting on the basis of
those possibilities, were things already present in unicellular creatures
before they became part of multicellular organisms, much less
multicellular organisms. with brain
Life and the need for life within the border that circumscribes the
organism precede the appearance of nervous systems, of brains. But
when the brains come on the scene, their theme remains life, and they
preserve and extend the ability to notice the internal state, to have the
different possibilities of acting and to use them to respond to changes
in the environment that surrounds the brains. Brains allow the need for
life to be regulated more effectively than ever and, from a certain point
in evolution, deliberately.
life management
Managing life poses different problems to different organisms in

different environments. Simple organisms in easy environments may
need little deliberation and no planning to be able to respond
appropriately and sustain life. Perhaps all they need is a small supply
of sensing devices, some ability to respond according to how they feel,
and some means of carrying out the action selected in response. In
contrast, complex organisms located in complex environments may
need large repertoires of knowledge, the ability to choose among many
available responses, the ability to construct novel response
combinations, and the ability to plan ahead in order to avoid
disadvantageous situations and instead encourage favorable ones.
The machinery required to perform these demanding tasks is

complicated and requires a nervous system. It requires a vast array
of possibilities, a substantial part of which must be provided by the
genome, to be innate, even though certain dispositions may be
modified through learning and additional arrays of dispositions may
be acquired through experience. The control of emotions, which we
have already examined before, is part of this arsenal of possibilities.
Also, various types of sensors are required; these sensors must be
able to detect diverse signals from the environments outside the brain
(the body) and outside the body (the outside world). The management
of life may also end up demanding means of responding not only
through actions carried out by the muscles but also through images
that represent internal states of the organism, entities, actions and
relationships.
Controlling life in a complex organism in a complex and not

necessarily favorable environment therefore requires a more profuse
innate poise, more sentience, and a greater variety of possible
responses than a simple organism would need in a simple
environment. But the least is the quantity. A new approach is needed
and nature has allowed it by developing two anatomical and functional
organizations. The first is to connect the brain structures needed to
manage the different aspects of the organism's life into an integrated
but multicomponent system. An analogy drawn from engineering
would be the connection of control panels: they are located in various
nuclei of the brain stem, the hypothalamus and the basal forebrain.
The second is to provide these controlling regions with a series of
continuous signals that originate in all parts of the body. These signals
provide the control regions (control panels) with a constantly updated
view of the state of the organism.
Some of the signals travel directly along nerve pathways and

indicate the status of organs (eg heart, blood vessels, skin). Other
signals travel through the bloodstream and are based on the
concentration of a hormone, glucose, oxygen, and carbon dioxide, or
the pH of the plasma. The signals are "read" by a number of neural
sensing devices that react differently depending on programmed
points on their "reading" scales. An analogy of these operations is
that of the thermostat in relation to climate control: a certain
temperature reading triggers a response (heat or cool until the desired
point is reached); there are certain values that do not provoke a
response. We can imagine certain parts of the central nervous
system, for example in the brain stem and hypothalamus, as a vast
field of thermostat-like detectors whose states of activity constitute a
graphic representation.
There are some risks to this analogy because the set points of a living
organism may undergo changes throughout its life, and may be
influenced in part by the context in which that sensing device operates.
This is understandable given that our thermostat-like detectors are
made of living tissue and not metal or silicone. For all these reasons,
Steven Rose has convincingly argued in favor of the use of the term
homeodynamics as opposed to homeostasis.3 However, the
essence of the analogy is still a good one.
Why are body representations suitable to indicate stability?
The reason body representations are well suited to indicate

stability stems from the remarkable invariance of body structures and
functions. Throughout development, the adult period, and even
senescence,
the body design remains virtually unchanged. It is true that the body
grows in size during development, but the fundamental systems and
organs are the same throughout life and the functions performed by
most of the components change little or not at all. This is generally
true of bones, joints, and muscles, and especially true of internal
organs and the internal environment. The range of possible states of
the internal environment and of the organs is narrowly limited. This
limitation is built into the requirements of the organism, since the
range of states compatible with life is small. That permissible range
is so small, and the need to respect its limits is so absolute for
survival, that organisms come to the fore equipped with a self-
regulating system to ensure that life-threatening deviations do not
occur or that life-threatening deviations do not occur. be corrected
immediately.
In short, not only is there a considerable part of the body that is

characterized by its minimal variation (we might even say "by its
relative sameness"), but living organisms naturally carry devices
designed to ensure limited or limited variation. , if you will, to maintain
the sameness. These devices are genetically implanted in every living
being and carry out their vital work whether the living being wants it
or not. Most beings don't 'want' anything else, but for those who do, it
doesn't matter at all: the basic regulatory devices continue to function
in the same way.
So if we seek a haven of stability in the universe of change that

is the world of our brain, there are worse options than the regulatory
devices that keep life in check along with the embedded neural
representations of the internal environment, internal organs, and
musculoskeletal framework. that represent being alive. The internal
environment, the organs and the musculoskeletal support produce a
continuous representation, dynamic but within a very narrow margin,
while at
Around us the world changes drastically, profoundly and often

unpredictably. The brain continuously has a dynamic representation
of an entity with a limited range of possible states: the body.4
ONE BODY, ONE PERSON: THE ROOTS OF THE SINGULARITY OF BEING
We might want to consider a fun test at this point. For every

person we know there is a body. We may never have stopped to
consider it, but there it is: a person, a body; one mind, one body...
one first principle.
We have never met a person without a body. We have not met a
person with two bodies or with multiple bodies, not even Siamese
twins. It is not given We may have known or known about bodies,
occasionally inhabited by more than one person, a pathological
condition known as multiple personality disorder (nowadays it has a
new name: dissociative identity disorder). However, even in this case,
the principle is not violated either, since, from time to time, only one
of the multiple identities can use the body to think and act, only one
of them obtains enough control to be a person and express itself (or
better yet, to express itself). The fact that it is not considered normal
to have multiple personalities reflects the general agreement that
each body corresponds to a being.
One of the reasons we admire good actors is that they can

convince us that they are a different person, that they have a different
mind and a different being. But we know that this is not the case, we
know that they are mere continents of skilful fantasy and we value
their work precisely because what they do is neither easy nor natural.
Now, intriguing thing: isn't it? Why shouldn't we normally find two
or three people in one body?
What economy of biological tissue. Or why shouldn't people with
great intellectual capacity and great imagination inhabit two or three
different bodies? What fun, what a world of possibilities. Why shouldn't
there be in our midst people without bodies, you know, ghosts, spirits,
creatures without weight and without color? Think about saving
space. But the plain and simple fact is that such creatures do not
exist today and nothing seems to indicate that they have existed and
the sensible reason that they do not exist and have not existed is that
the mind, which defines the person, requires a body and that the
body, the human body, of course, naturally gives rise to one mind.
The mind is so closely conformed to the body and designed to serve
it that only one mind can arise in it. Without body there is no mind.
For every body, never more than one mind.

Minds, destined for the body, help to save the body. When
creatures like us with conscious bodies and minds appeared, they
were, as Nietzsche called them, "hybrids of plants and ghosts," a
combination of limited, well-circumscribed, easily identifiable living
objects and unlimited, internal mental animation. , difficult to locate.
He also called these creatures "dissonances" because they possessed
a strange pairing between the clearly material and the seemingly
insubstantial. This pairing has stumped everyone for millennia and
may now be, to some extent, a little easier to understand than before.
can.5
THE INVARIABILITY OF THE ORGANISM AND THE FUGACITY OF THE PERMANENT
It is amazing to discover that the seeming rock-solid stabilities

behind mind and being are themselves ephemeral and are continually
being rebuilt as far as
cells and molecules. This strange situation (a paradox more apparent

than real) has a simple explanation: although the construction elements
of our organisms are replaced on a regular basis, the architectural
designs of the various structures of our organisms continue to be
carefully maintained.
There is a Bauplan for life and our body is a Bauhaus.
Consider the following.
We are not simply perishable at the end of our lives.
Most of us perish during our lives and are replaced by other perishable
parts. The cycles of death and birth repeat themselves many times
during a lifetime: some of our cells only survive a week, most no more
than a year; the exception are the precious neurons in our brains, the
muscle cells in our hearts, and the cells in the lens. Most components
that are not replaced (such as neurons) change through learning.
(The truth is that, since nothing is sacred, some neurons are even
replaced.) Life makes neurons behave differently by altering, for
example, their mode of connection with other neurons. No component
remains the same for long, and most of the cells and tissues that
make up our bodies are not the same as they were when we entered
high school. What does remain the same, for the most part, is the
construction plan of the structure of our organism and the predetermined
points for the functioning of its parts.
Let us call them spirit of form and spirit of function.6

When we discover what we are made of and how we are formed,
we discover a ceaseless process of construction and demolition, and
we realize that life is at the mercy of such a process. Like the sand
castles on the beaches of our childhood, it can be washed away. It is
amazing that we have a sense of being, that we have (that all or some
of us have) a certain continuity of structure and function that
it constitutes identity, some stable traits of behavior that we call

personality. It is certainly fabulous, surprising indeed, that you are
you and I am me.
But the problem goes beyond the condition of perishable beings
and the capacity for renewal. Just as the cycles of life and death
rebuild the organism and its parts according to a plan, the brain
rebuilds the sense of being moment by moment. We do not have
being carved out of rock and, like rock, resistant to the ravages of
time. Our feeling of being is a state of the organism, the result of
certain components that work in a certain way and that are related in
a certain way within certain parameters. It is another construction, a
vulnerable pattern of integrated functions whose consequence is the
generation of the mental representation of an individual living being.
The entire biological edifice, from cells, tissues and organs, to systems
and images, is kept alive by the constant realization of construction
plans, always on the verge of partial or total collapse if the construction
process is interrupted and of renovation. The building plans are all
woven around the need to move away from such an edge.
THE ROOTS OF THE INDIVIDUAL PERSPECTIVE, OF THE SENSATION OF OWNING AND

OF THE CONDITION OF BEING
What goes through our minds happens to us in a time and space

relative to the instant in which our body is and to the space it occupies.
Things are inside or outside of us. The ones outside are stationary or
moving. The stationary ones can be near or far from us or somewhere
in between.
Those that move can hover over us or move away from us or move
in a path that does not touch us, but our body is the reference.
Furthermore, the perspective
Experiential not only helps us to locate real objects but also to locate
ideas, whether concrete or abstract. The experiential perspective is a
source of metaphors for organisms endowed with such rich cognitive
capacities as very large conventional memory, working memory,
language, and other manipulative abilities that we group under the
term intelligence. For example, the notion of being is "close to my
heart," while the notion of homunculus is "far from my liking." In the
same way, the sensation of possessing and having the condition of
being an agent are completely related to a body at a specific moment
and in a specific space. The things we own are close to our body, or
should be close, so that they remain ours, which applies to things,
lovers, and ideas. Agent status, of course, requires a body to act in
time and space and is meaningless without it.
Let's imagine crossing a street and then think of an unexpected

car that approaches us quickly. The point of view relative to the car
that approaches us is the point of view of our body, and it cannot be
another. A person observing the scene from a window on the third
floor of the building behind us would have a different point of view:
that of his body.
The car approaches and our head and neck positions are altered to
orient us in its direction, while our eyes move in coordination to focus
on the rapidly changing features forming on our retinas. There is a
whole world of adjustments at work, from the vestibular system that
forms in the inner ear, which has to do with balance and serves to
indicate the position of the body in space, to the machinery of the
colliculi, which guide the movements of the eyes, neck and head with
the help of the nuclei of the brain stem, passing through the occipital
and parietal cortices, which modulate the process from a higher level.
But that is not all. Seeing a car approaching us at full speed causes
an emotion called fear, whether we like it or not, that changes many

things in our body: the viscera, the heart and the skin respond
immediately, among many others. Let me suggest that the signaling
of all those changes I have just enumerated is the means of producing
the perspective of the individual organism in our minds. Note that I
am not saying that it is the means to still experience our perspective
as an organism, which would be the same as knowing about it. The
experience or the knowledge of something, the conscience in a word,
comes later. Many of the changes that take place as the car
approaches happen to the multidimensional brain representation of
the body itself that existed briefly in the moments immediately before
the episode unfolded: they happen to the proto-being of our organism.
The person observing the scene from the third floor window has a
different perspective but undergoes similar formal changes in his
protoser.
I would say that perspective is continuously and irrevocably

constructed by processing signals from very diverse sources. First,
coming from a specific perceptual system; in our example, the optical
images that are formed on the two retinas. Second, from the various
adjustments that are carried out simultaneously by the different
muscular sections of the body and the vestibular system. In the
example, the retinal images change rapidly as a result of the
approaching object, but in order for them to stay in focus, adjustments
must be made in the muscles that control the lens and pupil, in the
muscles that control the position of the eyeball, and in the the muscles
that control the position of the head, body, and trunk.7 Finally, there
are signals from emotional responses to a particular object, most
marked in the case of a rapidly approaching car, and encompassing
changes in smooth muscles of the internal organs and occur in
various parts of the body. Note that, depending on the object, there
may be reaction ratios
different of
musculoskeletal and emotional, but both are always present. The

presence of all of these cues (in this particular example, from retinal
images, from muscular and postural adjustments, and from muscular,
visceral, and endocrine adjustments) describes both the object as it
hovers over the body and a part of the body's reaction to it. the
object as the organism regulates itself in order to maintain satisfactory
processing of the object.
There is no pure perception of an object in a sensory channel,

sight, for example. The changes that come together and that I have
just described are not optional. To perceive an object, visually or
otherwise, the organism requires specialized sensory signals and
signals from body adjustment, which are necessary for perception to
occur.8 The statement that there is no such thing as pure perception
remains true even in cases in which we were prevented from
moving, for example if we were given an injection of curare. After
injecting curare, none of our skeletal muscles move because the
curare blocks nicotinic receptors for the neurotransmitter acetylcholine.
And yet the "visceral" muscles involved in emotion can move freely
because curare does not affect their muscarinic receptors for
acetylcholine.
The statement also remains true when we merely think about an

object instead of actually perceiving it in the world outside our
organism. Here's why: the records we keep of objects and events
that we once perceived also include the motor adjustments we then
made to elicit their perception, and they also include the emotional
reactions we had. All of them are recorded together in memory, even
if it is in separate systems.
Consequently, even if we "merely" limit ourselves to thinking about

an object, we tend to reconstruct memories not only of a shape or a
color but also of the perceptual link that it required in its creation.
moment the object, as well as the emotional reactions that

accompanied it, no matter how mild they were. Whether we are
immobilized by a «curarization» or still in the dark, stuck in our
daydreams, the images that we form in our minds always send
signals to the organism about its connection with the subject of the
images and evoke some emotional reactions. Plain and simple, we
cannot escape from the affectation of our organism, especially motor
and emotionally, which is an art and part of having a mind.
For the melody you hear or the object you play, the perspective
is, naturally, the perspective of your organism, because it is obtained
from the modifications that your organism undergoes during these
events: hearing and playing. As for the feeling of ownership over the
images and the feeling of being an agent over those images, they are
also direct consequences of the machinations that create perspective.
They are inherent in those machinations as cementing sensory
evidence. Our creative and educated brain will end up clarifying that
evidence later in the form of the corresponding inferences, which in
turn are also known to us.
The perspective of the organism with which the images are

formed is essential for the preparation of the acts that involve the
objects that the images represent. The correct perspective in relation
to the oncoming car is important in designing the movement by which
we break away, and the same is true of the perspective relative to a
ball that we are supposed to catch. There, at that moment, is where
the automatic feeling of being an individual agent is born. Later we
will be able to make inferences with the same objective. The fact that
we have related to an object in order to create images of it makes it
easier to conceive of the idea of acting on the object.
You have to realize that even if all these changes occur, they are
not enough for you to become aware. Consciousness occurs when
we know and we can only know when we establish the relationship
between object and organism. Only then can we discover that all
those reactive changes described above are taking place in our own
organism and that they are caused by an object.
THE MAPPING OR REPRESENTATION OF BODY SIGNS
Among the major barriers to understanding the ideas explored

here are the prevailing, incomplete, and often confusing notions about
somatic signaling and the somatosensory system, which is supposed
to carry the signals. The word somatosensory, as its etymological
origin adequately indicates, describes the feeling of soma, a Greek
word that means "body." But often the notion evoked by soma is
more restricted than it should be. Unfortunately, when hearing the
words somatic or somatosensory , what usually comes to mind is
the idea of touch or the idea of muscular or joint sensation. However,
what happens is that the somatosensory system has many more
relationships and is not really even a single system. It is a combination
of various subsystems, each of which carries signals to the brain
about the state of many different aspects of the body. It is clear that
these different signaling systems came to light at different times in
evolution. They use different machinery in terms of the nerve fibers
that carry signals from the body to the central nervous system, and
they also differ greatly in the number, type, and position of central
nervous system relays on which they inscribe their signals. Even one
aspect of somatosensory signaling does not use neurons at all but
substances
chemicals found in the bloodstream. Despite these distinctions, these

various aspects of sensory signaling work in parallel and in close
collaboration to give, at multiple levels of the central nervous system
(from the spinal cord and brain stem to the cerebral cortexes), myriad
maps of the sensory aspects. multidimensional views of the state of
the body at a given time.
To give an idea of what these subsystems do and how they are

organized, I will group signaling into three fundamental divisions: the
visceral and internal milieu division, the vestibular and musculoskeletal
division, and the fine touch division.
The three divisions may work closely together or relatively
independently. When we touch an object whose texture gives us
pleasure, the signals from all three divisions have reached the maps
of the central nervous system that describe the interaction that takes
place in its many dimensions, for example, the movements with which
we investigate the object, the properties that activate the tactile
sensors and the visceral and humoral reactions that constitute the
pleasurable response to the object. But the divisions can work
independently, for example with very little intervention from the
second, or the first and second can work without the intervention of
the third. The important point to keep in mind is that the first division,
the one that deals with the interior of the organism, is permanently
active, constantly signaling to the brain the state of the most internal
aspects of the body itself. The brain is never excused in any normal
situation from receiving continuous information from the internal
environment and from visceral states, and under most conditions,
even without any active movement being made, the brain is also
informed of the state of its apparatus. musculoskeletal As I have
already indicated, the brain is truly the trapped and captive audience
of the body.
The internal and visceral milieu division is responsible for noticing

changes in the chemical milieu of cells throughout the body. The term
interoceptive generically describes these sensory operations. One
aspect of these signals bypasses nerve fibers and pathways entirely.
Chemicals flowing through the bloodstream are sensed by numerous
nuclei of neurons in some regions of the brainstem, hypothalamus,
and telencephalon. Nothing happens if the concentration of the
substance is within the permissible range. If the concentration is too
high or too low, the neurons respond: they initiate a series of actions
leading to the correction of the imbalance. For example, they can
calm us or make us tremble with fear, they can make us feel hungry
or longing for a sexual relationship, all of which are fascinating things,
no doubt, but the important thing is that the signals create, moment
after moment, multiple maps of the internal environment, as many as
the dimensions of our interior can be measured by this peculiar
method: and there are many measurable dimensions.
The exposure of the brain to chemicals circulating in the

bloodstream is remarkable. The brain is protected from the penetration
of certain molecules by the so-called blood-brain barrier, a biological
filter that surrounds practically all the blood vessels that transport
nutrients to the brain tissues and is highly selective about what can
or cannot pass through the blood to brain tissue. However, there are
a few brain regions that lack such a blood-brain barrier and readily
take in large molecules that cannot directly influence brain tissue in
other parts of the brain. Molecules that cross the blood-brain barrier
act directly on the brain, in places such as the hypothalamus; large
molecules that cannot cross the blood-brain barrier act on the brain
at certain places where the barrier is missing, the so-called
circumventricular organs. Examples of such places are
the area postrema (located in the brain stem) and the subfornical
organs (located at the level of the cerebral hemisphere). Neurons in
these areas, chemically excited, transmit their messages to other
neurons. The action of substances such as oxytocin, which is
essential for a whole series of behaviors, from sex and mating to
childbirth, depends on this organization. The immersion of the brain
in this chemical environment is a major issue.
The division of the internal environment and the viscera uses the
nerve pathways to carry the signals that we end up perceiving as
pain, which can originate practically in any part of the body, for
example in the abdominal viscera or in a joint or a muscle. That
division also carries neural signals related to aspects of the internal
environment, so that the body's chemical profile is transmitted not
only through the bloodstream but also through neural pathways; for
example, pH levels and carbon dioxide oxygen concentrations are
transmitted in duplicate.
Finally, this division also indicates the state of the smooth muscle,
which is so abundant in the viscera and has autonomous control. The
autonomous name indicates that a given process is controlled almost
entirely by devices independent of our will located in the brain stem,
in the hypothalamus and in the limbic nuclei instead of being in the
cerebral cortex. There is smooth muscle everywhere, for example in
any blood vessel in the body. This smooth muscle can contract or
expand to regulate circulation and its functions. One result of that
smooth muscle contraction or dilation is well known to us when it
increases or decreases our blood pressure, or when it makes the skin
pale or red. By the way, the largest organ of all is the skin itself. I am
not referring to the surface of the skin, which plays an essential role
in the sense of touch, but to the "thickness of the skin", which is vital
for temperature regulation. The
Extensive burns can kill us not because we lose tactile functions but
because our homeostatic regulation is severely disrupted. This
essential role of skin function comes from the ability to change the
caliber of the many blood vessels that run through it in all directions.
"I carry you under my skin" is a phrase that inadvertently captures
this important physiological idea, and the lyrics would have been even
more accurate if Cole Porter had said "I carry you in the thick of my
skin" while keeping all his mischief. Unsurprisingly, the French are
dead right when they say "Je t'ai dans la peau," which means "I
have you inside my skin."* The signals I have considered travel
through a particular section of the spinal cord (laminae I and II of the
posterior horn) and the nucleus of the trigeminal nerve (the pars
caudalis). However, I should add that the convenience of grouping all
these signals into a single large division obscures the structure of the
channel subdivision. For example, thanks to the work of A.
Craig, we know that the neurons that carry signals related to

nociception (pain) are different from those that mediate other aspects
of bodily sensation, although they all stimulate C fibers and A-ÿ
fibers.9 On the other hand, we also know that many signals related
to with the body they are not only transported separately to the higher
levels of the nervous system but also mixed and reassembled shortly
after entering the central nervous system. Something that occurs, for
example, in the deepest areas of each segment of the spinal cord.10
The complementary information for this division of the somatosensory
system comes from the organs and is transported by afferents from
the organs to the spinal cord and by nerves such as the vagus nerve
(which completely bypasses the spinal cord and enters directly into
the brain stem).
The second division, the musculoskeletal, brings to the central

nervous system the state of the muscles that join the moving parts of
the skeleton, that is, the bones. When the fibers
Muscle cells contract, the muscle length is reduced, and properly

connected bones are put into action.
When muscle fibers relax, the opposite happens.
We can control at will all the muscles that perform movements of the
skeleton and they are striated muscles (there is an exception to this
rule and that is the heart, whose muscle fibers are striated and not
smooth and are neither under volitional control nor in charge of
movement of the heart). any bony part). The function of this division
of the somatosensory system is known generically as the
proprioceptive or kinesthetic terms. As in the case of interoceptive
signals from the internal environment and organs, proprioceptive or
kinesthetic signals form numerous maps of the aspects of the body
they explore. These maps are located at multiple levels of the central
nervous system, from the spinal cord to the cerebral cortex. The
vestibular system, which represents the coordinates of the body in
space, completes the somatosensory information in this division.
A third division of the somatosensory system carries fine touch.

Their signals describe the alterations that specialized skin sensors
go through when we come into contact with another object and
investigate its texture, shape, weight, temperature, and so on. Just
as the internal environment and organs division deals primarily with
the description of internal states, the fine touch division deals primarily
with the description of external objects based on signals generated
by the surface of the body. The musculoskeletal division, which is a
kind of intermediate, can be used both to express internal states and
to help describe the external world.
THE NEURAL BEING

It is unlikely that the sense of being, both in its central version

and in its autobiographical version, were the original variants of the
phenomenon. My idea is that the sensation of being has a
preconscious biological precedent, the protoser, and that the earliest
and simplest manifestations of being emerge when the mechanism
that originates the central consciousness works on that non-conscious
predecessor.
The protoser is a coherent collection of neural patterns that
represent, moment by moment, the state of the physical
structure of the organism in its many dimensions. This
ceaselessly maintained first-order collection of neural patterns occurs
not in one place in the brain but in many, at many different levels,
from the brainstem to the cerebral cortex, in structures that are
interconnected by neural pathways. These structures are intimately
involved in the process of regulating the state of the organism. The
functions of acting on the organism and noticing the state of the
organism are closely linked. Protoser should not be confused with
the rich sense of being that our present knowing is focused on at this
very moment.
We are not aware of the protoser. Language is not part of the
structure of the protoser. The protoser has no capacity for perception
and does not store any knowledge.11 Nor is the protoser to be
confused with the rigid homunculus of ancient neurology. The
protoser does not occur in a single place and arises dynamically and
continuously from the many interrelated signals that encompass
various orders of the nervous system. Furthermore, the protoser
does not interpret anything: it is a point of reference at each point in
which it is located.
This hypothesis must be considered from the perspective of an
important qualification that has to do with the relationship between
brain regions and functions, such as the protoser. These functions
are not "localized" to one brain region or set of regions, but rather
are the product of the interaction of neural and chemical signals from
a set of brain regions.
regions. This is true of the non-conscious proto-self in relation to the

set of regions outlined below, and it is also true of functions such as
the central self or the autobiographical self, which will be discussed
later. Phrenological thinking must be resisted at all costs.
The structures that are required to constitute the protoser are

listed below, along with those that are not necessary for it. By
comparing the two lists, it is possible to test the hypothesis in various
ways. The most direct is to make predictions regarding the effects of
injury on key structures that appear on both lists. Some injuries should
alter the protoser and thereby more or less seriously alter
consciousness, while others should leave consciousness unharmed.
A first assessment of the validity of such predictions is possible on
the basis of available neuropathological and neurophysiological
evidence, but further exploratory studies are needed to consolidate
any conclusions.
Brain structures required to constitute the protoser
1. Various brainstem nuclei that regulate bodily states and

represent bodily signals. Along with the signaling chains that
begin in the body and end in the higher and more distal structures
of the brain, this region is the first in which an aggregate of nuclei
indicates the general state of the body, mediated by spinal cord
pathways. , the trigeminal nerve, the vagus complex, and the
area postrema. Included in this region are the classical reticular
nuclei, as well as the monoamine and acetylcholine nuclei.12 2.
The hypothalamus, which is located near and closely
interconnected with the structures listed in 1, and the basal
forebrain, which is located in the vicinity of
hypothalamus, is interconnected with the hypothalamus and the

brainstem and constitutes an extension of those lower structures
in the forebrain. The hypothalamus contributes to the current
representation of the body by keeping an up-to-date record of
the state of the internal environment in various dimensions, for
example the concentration of nutrients such as glucose in
circulation, the concentration of various ions, the relative
concentration of water, the pH, the concentration of various
hormones, and so on. The hypothalamus helps regulate the
internal environment by acting on these cues.
Figure 5.1. Location of some of the structures of the protoser. Note that the region
known as the insula is buried within the sylvian fissure and is not visible on the
cortical surface.
3. The insular cortex, the cortices known as S2 , and the middle

parietal cortices located behind the splenium of the corpus
callosum, all of which are part of the cortices
somatosensory In humans, the function of these cortices is

asymmetric. Based on my own observations in patients, I have
indicated that the ensemble of these cortices possesses in the
right hemisphere the most integrated representation of the
current internal state of the organism of all those that occur in
the cerebral hemispheres, together with the representations of
the invariant design of the brain. the musculoskeletal structure.
Jaal Panksepp also links body and self, in a recent article,
through an innate representation of the body in the brain stem.
His idea is close to my notion of proto-being in some respects,
although his view of how that representation contributes to
consciousness is completely different from mine.13
Brain structures that are not necessary to constitute the protoser
The structures listed below are not necessary to constitute the

protoser. This non-exhaustive list covers most of the central nervous
system. It comprises all of the earliest sensory cortices in their
external sensory modalities, which means that it comprises the visual
and auditory cortices, as well as the sectors of the somatosensory
cortices related to fine touch; all temporal and most higher-order
frontal cortices (higher-order cortices are those that are not exclusively
dedicated to one sensory modality but rather are dedicated to
supramodal formation of signals related to earlier sensory cortices)
and the hippocampal formation along with its interconnected cortices,
such as the entorhinal cortex (area 28) and the perirhinal cortices
(area 35). The list is as follows:
1. Several early sensory cortices, namely those in areas 17, 18,

and 19, devoted to vision; 41/42, 22 dedicated to hearing; area
37, which is partly dedicated to vision but is also a higher-order
cortex (see 2, below), and the part of S1 related to fine touch.
These cortices are involved in the fabrication of modality-specific
sensory patterns, patterns that support the mental images of the
various sensory modalities available to our minds. They have a
role in consciousness, both central and extended, insofar as the
object being known is made up of these regions, but they have
no role in the proto-being.
2. All of the inferotemporal cortices, namely areas 20, 21, part of

37, 36, and 38. These cortices are the basis of dispositional
(implicit) memories that can be reconstructed through recall in
the form of explicit sensory cues and images mental. These
cortices support many of the autobiographical registers on the
bases in which the autobiographical being can be composed
and the expanded consciousness can be produced.
3. The hippocampus, a vital structure in the «on-line» representation

of multiple and concurrent stimuli. The hippocampus receives
signals related to activity in all the sensory cortices, which arrive
indirectly at the end of various projection chains with multiple
synapses, and returns signals projecting in the opposite direction
along those same chains. It is essential for creating new
memories of events but not new memories of perceptual-motor
skills. It apparently harbors memories temporarily, but not
permanently. Most importantly, it seems to help establish
memories elsewhere, through connecting circuits.
4. The cortices related to the hippocampus, namely areas 28 and

35. These cortices can hold available memories of even greater
complexity than those seen in 2 above.
5. The prefrontal cortices. A wide array of higher order cortex. Some
of them harbor highly complex arrangements for personal
memories developed in unique temporal and spatial contexts; for
memories of relationships between different categories of events
or entities and somatic states, and for memories of abstract
concepts. Some of these cortices participate in high-level working
memory for spatial, temporal, and linguistic functions. Due to
their role in working memory, the prefrontal cortices are essential
for high levels of extended consciousness. Because of their role
in autobiographical memory, they are significant to the
autobiographical self and expanded consciousness.
6. The cerebellum. One of the most transparent but also most

elusive sectors of the brain. It is clearly involved in the construction
of fine movement: without it we cannot walk in a straight line, let
alone sing, play an instrument, or play tennis. However, it is also
involved in affective and cognitive processes, and I suspect even
more so during development. It can intervene in emotional and
mental search processes, such as searching for a word or non-
verbal item in memory. The absence of serious dysfunction after
ablation or inactivation suggests that its role in cognition is subtle.
But recent studies seem to indicate that this could be masking
due to inadequate observation, all the more likely due to the
patent anatomical and functional redundancy of the cerebellum.
SOMETHING TO KNOW
We have seen how a specific set of neural structures can support

the first-order representation of current bodily states that I call
protoser, and how, in doing so, they provide the roots of being, of
"that something to which knowing is attributed." ». It is time to say
something about the roots of the other key actor in the process: that
«something to know».
The backdrop for our understanding of how the brain represents
this unknown is vast. We have a considerable, though incomplete,
understanding of how sensory representations in major sensory
modalities (i.e., vision, hearing, touch) are related to signals arising
in peripheral sensory organs, such as the eye or inner ear, and how
those signals are transmitted to the respective primary sensory
regions of the cerebral cortex via subcortical nuclei such as those in
the thalamus. Beyond the primary sensory cortices, we understand
something about how explicit mental representations (those with an
overt structure) relate to various neural maps and how some memory
of such representations can be implicitly registered. We know, for
example, that the various aspects of an object (for example, its shape,
its color and its movement, or the sound it makes) are manipulated
relatively separately in cortical regions located below the respective
primary cortices. visual or auditory.
We suspect that a certain type of integrative neural process

contributes to originate, within the set of the region related to each
modality (the so-called early sensory cortices), the compound neural
activities that support the integrated image that we experience.14
However, we do not know all the intermediate steps between neural
patterns and mental patterns.
We know that the same general region underpins image making for
both perception (which we construct from the present scene outside
the brain, outside to inside) and memory (which we reconstruct
internally in the mind, inside to inside).
out, so to speak). We have reason to believe that the integration of

sensory representations across modalities (say vision and hearing,
or vision and touch) may well depend on synchronization mechanisms
that coordinate activity in large brain regions and probably need no
other single integrating space per se. se, of no single Cartesian
theatre. And we know for sure that basic sensory integration does not
require higher-order cortices in the anterior temporal and prefrontal
cortices.15 (See the appendix, section 3, for a more extensive
discussion of these issues.)
Let us now first consider the situation of an existing something to

be known, an existing object. Such an object is constituted in the
early sensory cortices, in those collections of cortex in which signals
from the various sensory channels such as vision, hearing, and touch
are processed, along with the many dimensions of the object such as
color, shape, and shape. , movement, hearing frequencies and so on.
The presence of such cues from an existing object elicits in the

organism the sort of response I have discussed earlier in this chapter,
namely, a collection of motor adjustments required to continue to
collect cues about the object as well as emotional responses to
various events. aspects of the object. In other words, the constitution
of that something to be known is inevitably accompanied by a complex
effect on the proto-being, that is, an effect on the very neural bases
of that something to which knowing is attributed. Let me repeat that
this is enough to be but not to know, that is, it is not enough to be
aware. As we will see, consciousness only arises when the object,
the organism and their relationship can be re-represented.
Let us now return to the case of an object that does not exist but,
rather, has been entrusted to memory. According to my scheme, the
memory of such an object is stored dispositionally. These provisions
are records that are latent and
implicit instead of being active and explicit, as images are. These

arranged memories of an object once perceived comprise not only
records of the sensory aspects of the object, such as color, shape, or
sound, but also records of the motor adjustments that necessarily
accompanied the collection of the signals. sensory; What's more,
memories also contain records of the compelled emotional reaction to
the object. As a consequence, when we recall an object, when we
allow those dispositions to make their implicit information explicit, we
retrieve not only sensory data but also accompanying motor and
emotional data. When we remember an object, we remember not only
the sensory characteristics of the existing object but also the organism's
past reactions to that object.
The significance of the distinction between existing object and

memorized object will become clear in the next chapter. I will advance
that meaning by saying that this distinction allows memorized objects
to originate central consciousness in the same way that perceived
existing objects originate it. That is why we can be aware of what we
remember just as we are aware of what we see, hear or touch in this
moment.
Were it not for such a magnificent organization, we could never have
developed an autobiographical being.
NOTE ON THE DISORDERS OF THAT SOMETHING TO KNOW
Disorders of that something to be known fall into one of two broad

categories: perceptual disorders and agnosias. In perceptual disorders,
the lack of signals from a sensory modality such as vision or hearing or
the somatosensory division of touch prevents the sensory representation
of the object from forming: sudden blindness or deafness is an example
of this. Under those circumstances, an object X that should be
represented
through a particular sensory channel can no longer be represented,

fails to stimulate the organism in the usual way, and does not modify
the protoser. The result is that no central consciousness arises.
Let's look at the second category, the agnosias. The word
agnosia is obscure but well-formed and denotes the inability to
extract from memory the kind of knowledge relevant to a given object
while it is being perceived. What is perceived is stripped of meaning,
as an old and lapidary definition stated. The exemplary form of
agnosia is the lesion known as associative agnosia, to use technical
neurological terms. Associative agnosia occurs in relation to the main
sensory modalities, that is, there are cases of visual agnosia, auditory
agnosia and tactile agnosia.
Due to their exquisite specificity, they make up some of the most
intriguing cases in neurology. As will be seen in the exemplification
that follows, a perfectly healthy and intelligent human being may be
deprived of the ability to recognize familiar people by sight but not by
sound (or vice versa).
It must be me because I'm here
That's what Emily said cautiously as she gazed at her face in the
mirror before her. It had to be her; she had placed herself in front of
the mirror, of her own volition, so it had to be her: who else? And yet
he couldn't recognize himself in the mirror; Of course it was the face
of a woman, but whose? He didn't think it was his own and he couldn't
confirm it because he couldn't imagine his own face. The face he was
looking at did not evoke anything concrete in his mind. I could believe
it from the circumstances: it was I who had taken her to that room and
who had asked her to walk to the mirror and
tell who you see. The situation told her unequivocally that it couldn't
be anyone else, and she accepted my statement that of course it was
her.
However, when I hit play on the recorder and let him hear a
recording of his own voice, he immediately recognized it as his own.
He had no difficulty in recognizing her voice even though he couldn't
recognize her face. That same disparity applied to the faces and
voices of others. She could not recognize her husband's face, or her
children's, or the faces of other relatives, friends or acquaintances.
However, he could easily recognize their respective voices.
Emily was not very different from David in that "nothing came to
mind" when she was shown certain particular items. But it was vastly
different in that his problem was exclusively in the visual world.
Nothing came to her mind only when she was shown the visual
aspect of a singular stimulus with which she was thoroughly familiar:
a person's face, a particular house, a particular vehicle.
The nonvisual aspects of those same stimuli (for example, sound or

touch) brought to mind whatever they were supposed to bring to
mind.16 Emily had a better response when it came to something not
so unique. It was remarkable that he was able to tell what
emotion was being expressed by a face whose identity he no longer
had access to. The same was true for the age and sex of the person
with a given face.17 His difficulty only concerned the unique elements
in the visual medium.
How does Emily fit into my core consciousness checklist? The

answer is: perfectly. I need not add that she is awake and attentive in
every way. Focuses attention easily and maintains it for all kinds of
tasks. The emotions and feelings it conveys are also entirely normal.
Behaves deliberately and appropriately in any context, both immediate
and long-term, only limited
for his visual difficulties. The truth is that, even despite such difficulties,
he can achieve remarkable intellectual feats.
He sits for hours and hours watching people go by and makes
attempts to find out who they are, usually quite successfully; she can
perfectly hold conversations with her guests when they arrive at her
house, as long as her husband can whisper the name of the person
who is visually unknown to her; and she can recognize her car, visually
unknown to her, in the supermarket parking lot by systematically
checking all license plates.
However, I want to draw your attention to something quite

revealing. Not only is he perfectly aware of what he knows, but he is
also perfectly aware of what he doesn't know. For each stimulus that
is presented to him, he generates central consciousness regardless
of the amount of knowledge that he is able to evoke for each stimulus.
Emily, like many other patients I have studied over the years, is acutely
aware of the things she doesn't know and examines those things in
relation to her knowing self just as she examines the things she does
know.
Let's look at the next experiment we set up specifically for Emily.
We had noticed, almost by chance, that when presented with a

long sequence of photographs to test her recognition of various
people, and seeing a photo of an unknown woman with one of her
upper teeth slightly darker than the rest, Emily dared to say that it was
his daughter.
"Why do you think she is your daughter?" I remember asking him.
"Because I know Julie has a darker upper tooth," he said. I bet it's
her.
Of course it wasn't, but the error revealed very well the strategy
our clever Emily had to rely on.
Unable to recognize identity from overall features
and of the more localized sets of features of the face, Emily would
cling to any single feature that might remind her of anything potentially
related to any person she might reasonably be asked to recognize.
The dark tooth reminded her of her daughter and on that basis she
made the reasonable guess that it was her daughter without a doubt.
In order to test the validity of this interpretation, we designed a

simple experiment. We modified a few photos of smiling men and
women to show a slightly darker upper incisor and randomly
interspersed them among many other photos. Whenever Emily came
across a doctored photo of a young woman (it never happened with
men or older women) she would say it was her daughter. He was
acutely aware of the whole and the parts of the photos he was shown,
because otherwise he would not have been able to reason so
intelligently, photo after photo, and he would not have been able to
fix his attention on the object stimulus. . At a minimum, Emily and
those like her demonstrate that specific knowledge of an element at
a single level is not required in order to have core awareness of that
element.
When a patient with facial agnosia fails to recognize a familiar

face in front of him and declares that he has never seen such a
person, that he does not remember anything related to that person,
the relevant knowledge is not presented to the conscious search but
the central consciousness still intact. The truth is that once the patient
is confronted with the fact that the face in front of him is that of a
close friend, the patient is not only aware in general, but is also aware
of his failure, aware of his inability. to evoke any knowledge that is
useful for the recognition of the intimate friend. It is not a problem of
conscience but of memory. That specific something to be known has
been lost: it cannot represent the knowledge of who this person is
that it is looking at, it cannot be aware that something is present. But
it is present
central consciousness originated by other layers of that something to

be known, for example the face as such, as something different from
the face of a singular person. Precisely because normal central
consciousness is present, it knows of the recognition gap that exists.
Figure 5.2. The lesions that caused prosopagnosia in patient Emily were
located at the junction of the occipital and temporal lobes of both hemispheres.
This is the characteristic location of lesions in patients with associative
prosopagnosia.
Emily's problem was caused by a bilateral lesion in the early

visual cortices, specifically the visual association cortices located at
the transition from the temporal to the occipital lobes on the ventral
aspect of the brain. Brodmann's areas 19 and 37, in the region known
as the fusiform gyrus, bore the brunt of the injury.
On the basis of our first neuroimaginary correlations in relation to

facial agnosia from almost two decades ago, we suggest that these
cortices are normally involved in processing faces and other
ambiguous visual stimuli that place similar demands on the brain.18
The experiments Current functional neuroimaginaries support the
idea that normal individuals consistently activate the damaged region
of Emily's brain when they are aware of face processing.19 It is
important to note that activation of this area in a experiment
neuroimaginary function should not be interpreted to mean that

'consciousness for faces' occurs in the so-called facial area. The
image of the face of which the subject is aware cannot occur without
a neural pattern organizing in the facial area, but the rest of the
process that gives rise to the sense of knowing that face and
draws attention to the pattern is taking place. elsewhere, in other
components of the system.
The importance of this qualification cannot be seen more clearly
than when we consider the following fact: when an unconscious
patient in a persistent vegetative state was shown familiar faces, the
so-called "facial area" (at the occipito-temporal joint, within the
fusiform gyrus ) lit up in a functional graphic scanner, similar to how
it lights up in normal, sentient people. that consciousness is no longer
manufactured.
Bilateral damage to the auditory cortices yields the same results

as damage to the visual cortices with respect to central consciousness.
Just as Emily does not evoke specific knowledge pertaining to
singular items such as familiar people or objects, patients with
damage within specific regions of the auditory sector of the cerebral
cortex lose the ability to evoke specific knowledge related, for
example, to melodies that were previously familiar or with the
previously familiar voice of a particular person. The patient known in
my laboratory as patient X illustrates this situation.
He is an established and successful opera singer who, as a result of

a stroke, lost the ability to recognize the singing voices of his
colleagues with whom he had sung all over the world. As for his own
singing voice he couldn't recognize it anymore either. He also lost
the ability to identify
familiar melodies including those of arias he had sung hundreds of

times during his long career. As in Emily's case, it was outside the
realm of the auditory and, as in Emily's case, it appropriately gave
rise to central awareness for stimuli that it was no longer capable of
knowing in the proper sense of the term. He scrutinized every
unrecognized piece with the utmost meticulousness, searching in
each tone, in each shade of timbre and color, a possible clue to the
identity of the singer who sang it. The only voice he recognized
without fail was that of Maria Callas, perhaps as further proof that
Callas was of a separate race.
Both Emily and X have lesions within the association, visual, and
auditory cortices, respectively. It is therefore clear from the study of
numerous cases like his that extensive damage to these sensory
cortices does not endanger central consciousness. As far as extensive
damage to the early sensory cortices is concerned, only damage to
the somatosensory regions results in altered consciousness, for the
reasons given above: the somatosensory regions are part of the base
of the protoser and their damage can easily alter the basic mechanisms
of central consciousness.
Now that we know how the brain can put together the neural
patterns that represent an object and the neural patterns that
represent an individual organism, we are ready to consider the
mechanisms that the brain might use to represent the relationship
between the object and the organism: causal action of the object on
the organism and the resulting possession of the object by the
organism.
CHAPTER SIX
THE CONSTRUCTION OF CENTRAL CONSCIOUSNESS
THE BIRTH OF CONSCIOUSNESS
How do we begin to be aware? And specifically, how do we

begin to have a feeling of being in the act of knowing?
We start with a first trick. The trick is to build a relationship of what
happens inside the organism when the organism is related to an
object, whether it is actually perceived or remembered, whether it is
within the boundaries of the body (for example, pain) or outside them
(for example, pain). for example, a landscape). This relationship is a
simple narration without words. It has characters (the organism, the
object). It develops over time. It has a beginning, a middle and an
end. The beginning corresponds to the initial state of the organism.
The development corresponds to the arrival of the object. The end is
made up of reactions that result in a modified state of the organism.
So we become conscious when our organisms internally construct

and internally display a certain specific wordless knowledge (the
knowledge that our organism has changed through the mediation of
the object) and when that knowledge is given in conjunction with the
salient internal presence of the object. The simplest form in which this
knowledge emerges is the sensation of knowing, and the enigma
before us is summed up in the following question: By what sleight of
hand is such knowledge accumulated, and why does knowledge first
arise in the form of sensation?
The specific answer that I have deduced, I present it in the

following hypothesis: that central consciousness occurs when the
representation devices of the brain originate a non-verbal report
and in images of how the state of the organism is affected by the
processing that the organism makes of the object and when this
process highlights the image of the causing object, thereby
placing it prominently in a spatial and temporal context. The
hypothesis outlines two component mechanisms: the generation of a
nonverbal and imagery account of the organism-object relationship
(which is the source of the sense of being in the act of knowing) and
the enhancement of images of an object. As regards the component
of the feeling of being, the hypothesis is based on the following
premises:
1. Consciousness depends on the internal construction and display

of new knowledge regarding an interaction between that organism
and an object.
2. The organism, as a unit, is mapped in the brain of the organism,
in the structures that regulate the life of the organism and that
continuously signal its internal states; the object is also mapped
in the brain, in the sensory and motor structures activated by the
relationship between organism and object; both organism and
object are mapped as neural patterns, in first-order maps; all of
these neural patterns can be converted into images.
3. The sensorimotor maps that refer to the object cause changes in

the maps that refer to the organism.
4. The changes described in 3 can be seen in turn represented in
other maps (second order maps) that therefore represent the
relationship between organism and object.
5. Neural patterns that are temporarily formed on second-order maps
can be converted into mental images, just as neural patterns on
first-order maps can be.
6. Due to the corporeal nature of the maps of the organism and the
maps of the second order, the mental images that describe the
relationship are sensations.
I point out again that the core of our investigation here is not the
question of how neural patterns on any map can be turned into mental
patterns or images: that is the first problem of consciousness as
outlined in Chapter 1. in the second problem of consciousness, the
problem of being.
As far as the brain is concerned, the organism of the hypothesis

is represented by the protoser. The key aspects of the organism
addressed in the report are those that I already indicated that the
protoser provided: the state of the internal environment, of the organs,
of the vestibular system and of the musculoskeletal framework. The
report describes the relationship between the changing protoser and
the sensorimotor maps of the object that causes such changes. In
short: just as the brain forms images of an object (such as a face, a
melody, a toothache, the memory of an event) and just as the images
of the object affect the state of the organism, there is also another
level of the brain structure that creates an immediate nonverbal report
of the events that are taking place in the various brain regions that
have been activated as a result of the object-organism relationship.
The mapping of consequences related to the object occurs in the first-
order neural maps that represent the protoser and the object; the
report of the causal relationship between object and organism can
only be captured in second-order neural maps. In retrospect, with the
license provided by a metaphor, we could say that the second-order
nonverbal instant report tells a story: that of the organism caught in
the act of enacting its own state.
changing while representing something else. But the surprising

fact is that the knowable entity that grasps has been created precisely
in his narrating the process of grasping.
This pattern repeats itself endlessly for each object that the brain
represents, and it doesn't matter if the object exists and is related to
the organism or if it is retrieved from a past memory. It also doesn't
matter what that object actually is. In healthy individuals, as long as
the brain is awake, the image-making and consciousness machines
are running, and we are not manipulating our mental state by doing
meditation-like things, it is not possible to run out of "existing" objects.
or without "thought" objects and therefore it is not possible to be
without that abundant item called central consciousness. There are
simply too many objects, existing or remembered, and often more
than one object at a time.
The web of images itself feeds abundantly into the fluid process we
call thought.1 The wordless narrative I posit is based on neural
patterns that become images, these images being the very
fundamental currency in which the description takes place. of the
object that originates consciousness. Most importantly, the images
that make up this narrative are incorporated into the stream of thought.
The images of this narrative stream flow like shadows along with the
images of the object to which they provide unsolicited and involuntary
comment. To return to the metaphor of the movie projected inside the
brain, they are inside the movie. There is no outside spectator.2 Let
me conclude my presentation of how I believe central consciousness
arises by addressing the second component of the hypothesis. The
process that gives rise to the first component (the nonverbal and
imagery report of the relationship between object and organism) has
two clear consequences. One consequence, already presented here,
is the subtle image of knowing, the sensitive essence of our sense of
being; the other is the enhancement of the image of the object
causative, which dominates the central consciousness. The attention is

focused on an object and the result is the highlighting of the images of that
object in the mind. The object stands out among other less fortunate
objects: it is selected as a particular occasion in both the Jamesian and
Whiteheadian senses. It becomes a fact following the preceding events
that lead to its appearance and is part of a relationship with the organism
to which all this is happening.
You are the music while the music lasts: the temporary central being
You know that you are aware, you feel that you are in the act of
knowing, because the subtle imagery report now flowing through your
organism's stream of thought presents the knowledge that your protos-self
has been modified by an object you have just touched. stand out in your
mind. You know that you exist because the narrative presents you as the
protagonist in the act of knowing. You rise above the level of the sea of
knowing, temporarily but incessantly, as a central felt being, renewed
again and again, thanks to something reaching your sensory machinery
from outside the brain or something coming from the storehouses The
memory function of the brain is directed at sensory, motor, or autonomic
recall. You know that it is about what you see because the story represents
a character (you) seeing. The first basis for the conscious you is a
sensation arising from the re- enactment of the unconscious proto-self
in the process of being modified within a report that establishes the
cause of the modification. The first trick behind awareness is the creation
of that report, and its first result is the sense of knowing.
In this story, knowing becomes concrete, it is inherent in that newly

constructed neural pattern that constitutes the non-verbal story. We barely
notice the narrative because the images that
dominate the mental display are those of things we are already aware of
(the objects we see or hear) rather than those that instantly constitute
sensing ourselves in the act of knowing. Sometimes all we are aware of is
the murmur of the subsequent verbal translation of an inference related to
the story: yes, it is I who sees or hears or touches.
But however weak, half-guessed as this innuendo often is, when the
narrative is interrupted by neurological disease, our consciousness is
suspended as well, and the difference is monumental.3 TS Eliot might as
well have been thinking about this process I just described. describe when
he wrote in his Four Quartets about "music heard so deeply that it
is not heard at all" and when he said "you are the music while the music
lasts". At least he was thinking about the fleeting moment when insight
can arise: a union, or incarnation as he called it.
Beyond the central temporal self: the autobiographical self
However, something remains after the music has disappeared; some

residue remains after many emergences of the central being. In complex
organisms such as our own, equipped with vast memory capacities, the
fleeting moments of knowledge in which we discover our existence are
facts that can be entrusted to memory, properly categorized and related
to other memories that correspond both to the past and to the future.
anticipated. The consequence of such a complex memorization operation
is the development of autobiographical memory, an aggregation of
available records of what we have physically been and what we have
used to be behaviorally, along with records of what we plan to be in the
future. We can increase this aggregate
memory and reshape it as we go through life.

When, as needed, certain concrete registers are made explicit by
reconstructing them as images, in smaller or larger quantities, they
become the autobiographical self. For me, the real wonder is that
autobiographical memory is architecturally connected, neurally and
cognitively speaking, to the non-conscious proto-self and to the
emergent and conscious central being of each lived moment. That
connection forms a bridge between the progressive process of
central consciousness, condemned to a sisific transience, and a
progressively larger array of established, rock-solid memories
corresponding to unique historical facts and consistent characteristic
features of a certain individual. In other words, the body-based, range-
bound stability of the non-conscious proto-self, which is reconstructed
over and over again at every instant, and the central self, which
emerges from it in the second-order nonverbal story that follows.
produced when an object modifies it, they are enriched by the display
that accompanies them of memorized and invariant facts, for
example, where we were born, whose children we are; pivotal events
in our autobiography, our likes and dislikes, our name, and so on.
Although the basis of the autobiographical self is stable and invariant,
its scope continually changes as a result of experience. The unfolding
of the autobiographical self is therefore more open to remodeling
than the central self, which is reproduced over and over again in
basically the same way throughout life.
Table 6.1. kinds of being
AUTOBIOGRAPHICAL SELF: The autobiographical self is based on autobiographical memory that is

made up of implicit memories of multiple instances of individual experience, past or anticipated future.
The invariant aspects of individual biography form the basis of autobiographical memory.
Autobiographical memory continually grows with life experience but may be partly remodeled to
reflect new experiences. Memories that describe identity and personhood can be reactivated as
neural patterns and can be made explicit as images whenever needed. Each of these reactivated
memories functions as a "something to know" and generates its own pulse of central consciousness.
The result is the autobiographical being of which we are aware.
CENTRAL BEING: The central being is inherent in the second-order non-verbal account that occurs
whenever an object modifies the protoser. The central being can be fired by any object. The
mechanism of production of the central being undergoes minimal changes throughout life. We are
aware of the central being.
AWARENESS
PROTOSER: The protoser is an interconnected and transiently coherent collection of neural patterns
that represent the state of the organism, moment after moment, and at multiple levels of the brain.
We are not aware of the protoser.
Table 6.2. How to distinguish the central self from the autobiographical self
CENTRAL SELF: AUTOBIOGRAPHICAL SELF:

The transitory protagonist of Based on the permanent but
consciousness, generated by any object available records of the experiences of the
that triggers the mechanism of central central self. These registers can be activated
consciousness. Thanks to the permanent in the form of neural cues and transformed
availability of stimulus-objects, it is into explicit images. The registers are
generated continuously and therefore partially modifiable through later experiences.
appears to be continuous over time.
The mechanism of the central being The autobiographical being requires

demands the presence of the protoser. the presence of a central being to
The biological essence of the central being initiate its gradual development.
is the representation of the protoser, on a
second-order map, in the act of being
modified.
Being autobiographical also

requires the mechanism of central
consciousness, so that the
activation of your memories can
generate central consciousness.
Unlike the central self, which is inherent in the primordial

narrative as the protagonist, and unlike the proto-self, which is
an actual representation of the state of the organism, the
autobiographical self is concept-based, in the true cognitive and
neurobiological senses of the term. The concept exists in the
form of implicit and available memories that are contained in
certain interconnected brain networks and many of these implicit
memories can be made explicit simultaneously and at any time.4
Its activation in the form of an image constitutes a backdrop for
each of the moments of a healthy mental life, curtain that is
generally ignored, often half hinted and half guessed at, just like
being central and just like knowing, and yet ready to be even
more central in the case that we need to confirm that we are who
we are. That is the material we use when we describe our
personality or the individual characteristics of another person's
way of being. We will see more of this in the next chapter, as we
examine expanded consciousness and the mechanisms behind
identity and personhood.
From a developmental perspective, I have for myself that in

the early stages, there is not much more to our being than
repeated states of our core being. However, with increasing
experience, autobiographical memory grows and the
autobiographical self can unfold. Possibly the milestones
identified in child development are the result of an uneven
expansion of autobiographical memory and an uneven
deployment of the autobiographical self.5
Regardless of how well the autobiographical memory grows and

how robust the autobiographical self becomes, it should be clear that
they require a constant supply of central consciousness if they are to
be of any use to their possessing organism. The contents of the
autobiographical being can only be known when there is a recent
construction of a central being and knowing for each of the knowable
contents. A patient on the threshold of an epileptic automatism episode
has not yet destroyed his autobiographical memory and yet cannot
access its content. When the attack ends and the central consciousness
returns, the bridge is reestablished and the autobiographical being
can be called upon for whatever is needed. In other words, although
the contents of the autobiographical self belong to the individual in an
absolutely unique way, they also depend on the gift of central
consciousness to be revived like any other something to be known. It
may be a bit unfair but it must be so.
COMPOSITION OF CENTRAL CONSCIOUSNESS
I conceive of central consciousness as being created by impulses,

each triggered by each and every object we relate to or remember.
Let's say that a pulse of consciousness begins the instant before a
new object triggers the proto-being's change process and ends when
a new object begins to trigger its own changes. So the protoser
modified by the first object becomes the inaugural protoser for the
new object. A new pulse of consciousness begins.
The continuity of consciousness is based on the continuous

generation of pulses of consciousness that corresponds to the
incessant processing of myriads of objects, whose interaction, real or remembered
constantly modifies the protoser. The continuity of consciousness

comes from the abundant flow of nonverbal narratives from the
central consciousness.
It is likely that more than one narrative will be created at a time.
And this because at the same time it can be related to more than one
object, although there cannot be many, and therefore more than one
object can induce a change in the state of the protoser. When we
speak of "stream of consciousness," a metaphor that seems to
indicate a single path and a single sequence of thoughts, it is not
likely that the part of the stream that carries consciousness arises
from a single object, but from several. What is more, it is also likely
that the interaction with each object generates more than one
narrative, since various levels of the brain may be involved. And in
turn, this type of situation seems beneficial because it would produce
an overabundance of central awareness and ensure the continuity of
the state of "knowing." I will expand on the issue of multiple core
consciousness generators in the pages that follow.
THE NEED FOR A SECOND-ORDER NEURAL PATTERN
Telling the story of the changes wrought on the inaugural protoser

by the interaction of the organism with any object requires its own
process and its own neural basis. In the simplest terms, I would say
that in addition to the many neural structures in which the causing
object and the protoser are separately represented, there is at least
one more structure that re-represents the protoser and the object in
their temporal relationship and that for this reason it can represent
what is happening to the organism: protoser in the inaugural
instant, object that becomes sensory representation, change of
the inaugural protoser into protoser modified by the object.
However, I suspect that there are several structures in the human
brain capable of causing a neural pattern of
second order that re-represents the first order events. The second-
order neural pattern underlying the nonverbal and imagery account
of the organism-object relationship is probably based on highly
intricate cross-signaling between various "second-order" structures.
The probability that a single brain region bears the supreme second-
order neural pattern is slim.
The main characteristics of the second-order structures whose

interaction originates the second-order map are the following. A
second-order structure must be capable of: 1) receiving signals via
signals received via the axon from locations that are involved in
representing the protoser and from locations that can potentially
represent an object; 2) to originate a neural pattern that «describes»,
in a temporally ordered way, the events that occur in the first-order
maps; 3) to introduce, directly or indirectly, in the general flow that we
call thought that image resulting from the neural pattern; and 4) to
return the signal, directly or indirectly, to the structures that process
the object in such a way that the image of the object can be highlighted.
An outline of this general idea is presented in Figure 6.1.

A second-order structure receives a succession of signals related to
an event that is developing and that occurs in various brain locations:
the formation of the image of object X, the state of the protoser as the
image of X begins to form, the changes in the protoser caused by the
processing of X.
This succession of re-representations constitutes a neural pattern
that becomes, directly or indirectly, the basis of an image: the image
of a relationship between object X and the protoser altered by X. Let
me stress again that this is a simplification of the idea. In all probability,
and because there are several second-order structures, the neural
pattern and image of the relationship will be the result of cross-
signaling between those second-order structures. Note also that,
As we have seen before, the process of central consciousness is not

restricted to the generation of this story in images. The presence of
the story pattern in a second-order neural pattern has important
consequences: it influences the object's maps by modulating its
activity and thus enhances the conspicuousness of those patterns for
a short time.
Figure 6.1. A. Second-order neural pattern components composed in their

temporal sequence in a second-order structure. B. Emerging second-order
image map and enhanced map of the object.
Where is the second order neural pattern located?
It is important to consider possible anatomical sources of the

second-order pattern. My favorite guess is that the second-order
neural pattern arises temporarily from interactions between a few
special regions. It will not be found in a single brain region (in a kind
of center of consciousness in the phrenological way), but it will not
be everywhere or anywhere. The fact that the second-order neural
pattern
is located in more than one place may surprise you at first, but it
shouldn't. I believe that it follows what is rather a general rule of the
brain and not an exception.
Think, for example, what happens with movement. Imagine that you
are in a room and a friend comes in to ask you to borrow a book. You
get up, walk, pick up the book as you go, and start talking; your friend
says a funny thing and you laugh.
You make movements with your whole body, when you get up and
when you start to move, adopting a certain posture for this purpose;
his legs move, as does his right arm; the same goes for parts of your
speech apparatus, the muscles of your face, your rib cage and
diaphragm when you laugh. As in the analogy of behavior in an
orchestral performance, there are half a dozen different motor
generators , each fulfilling its role, some under voluntary control
(those that help you pick up the book) and others not (those that
control body posture or Laughter). However, all of them are
fantastically coordinated in time and space, so that you execute your
movements very smoothly, giving the appearance that they all come
from the same source and through a single will. We have few clues
as to how and where that blending and smoothing occur. Undoubtedly,
all this occurs with the help of a good part of the circuits of the brain
stem, the cerebellum and the basal ganglia, interacting through
crossed signals. Of course it is not known precisely how.
I now transfer these same conditions to my conception of central

consciousness. Here I also want to suggest that there are multiple
generators of consciousness at different brain levels and yet it seems
to be a smooth process, centered on a knowing being and an object.
It seems reasonable to assume that under normal circumstances
several second-order maps relating to different aspects of an object's
processing are created at the same time, in roughly the same time
interval. For that object, the central consciousness would be the result
of composing
second-order maps, an integrated neural pattern that would give rise

to the story in images that I have proposed above and would also
lead to the enhancement of the object. I don't know how the blending,
blending and smoothing are achieved but it is important to realize that
this mystery is not about consciousness alone; it also belongs to other
functions such as movement. Maybe when we solve this one, we will
also solve the other one.
There are various brain structures capable of receiving converging
signals from various sources and therefore apparently capable of
developing second-order maps. In the context of this hypothesis, the
second-order structures I have in mind must achieve a specific
conjunction of signals from "whole organism maps" and "object maps."
Respecting such requirements regarding the source of the signals to
be assembled eliminates some possible candidates, such as the
higher-order cortices of the temporal and parietal regions, the
hippocampus, and the cerebellum, whose roles enter the first-order
representation. Furthermore, the second-order structures required by
the hypothesis must be able to influence first-order maps so that
enhancement and cohesion of the object images can occur. Once
you factor in this requirement as well, the finalists for second-order
structures are the superior colliculi (those twin hill-like structures at
the back of the midbrain, known as the tectum); the entire region of
the cingulate cortex; the thalamus and some prefrontal cortex.
I suspect that all these finalists have their role in consciousness, that
none of them act separately and that the scope of their contribution is
varied. For example, I doubt that the superior colliculi are especially
important in human consciousness, and I suspect that the prefrontal
cortices are probably only involved in extended consciousness. Figure
6.2 provides a rough idea of where such structures are.
Central to the hypothesis is the notion of interaction between

such structures. For example, when it comes to central consciousness,
I think the superior colliculi and cingulate cortices each put together a
second-order map on their own. However, the second-order pattern
that I hypothesize as the basis of our sense of knowing is supraregional.
It would be the result of the joint composition of the superior and

cingulate colliculi, supervised by the thalamus, and it seems sensible
to accept that the cingulate and thalamic components would take the
lion's share in that composition.
Figure 6.2. Location of the second order representation structures mentioned in

the hypothesis.
The consequent influence of second-order neural cues on object

image enhancement is achieved in a number of ways, including
thalamocortical modulation and activation of basal forebrain and
brainstem acetylcholine and monoamine nuclei, all which then affect
cortical processing. It is interesting to note that the second-order
structures I propose certainly have the means to exert such an
influence.
The list of neuroanatomical devices that are required to shape

consciousness continues to grow, as can be seen, but fortunately it
remains circumscribed. That list includes the
select number of structures needed to make up the protoser (some

brainstem, hypothalamus, and basal forebrain nuclei, some
somatosensory cortices), as well as the structures listed here as
possible second-order map locations. In chapter 8 I reflect on the
plausibility that all of these structures are involved in the fabrication
of consciousness.
THE IMAGES OF KNOWING
The first utility of the narrative in images of the organism-object

relationship is to inform the organism of what it is doing or, in other
words, to answer the question that the organism never asked: What
is happening? What is the relationship between images of things and
this body? The feeling of knowing is the beginning of the response. I
have already outlined the consequences of acquiring this unsolicited
knowledge: that it is the beginning of the freedom to understand a
situation, the beginning of the subsequent possibility of planning
responses that differ from the Duchampian "ready-mades" provided
by nature.
However, as I have already suggested, there is an immediate
secondary utility to the process leading to the picture story.
When the suitably equipped brain of an alert organism gives rise to
central consciousness, the first result is more to be alert: let us
realize that some alertness was already available and that it was
necessary to get the thing rolling. The second result is more focused
attention on the causing object: here, too, some attention was already
initially available. Both results are achieved by enhancing the first-
order maps that represent the object.
To a certain extent, the implicit message in the conscious state

is: "You have to focus your attention on X." Awareness results in
heightened alertness and focused attention , thus being
that both improve image processing for certain content and therefore
can contribute to optimizing immediate and planned responses. An
organism's attachment to an object enhances the organism's ability
to process the object sensorily and also increases the likelihood of
attachment to other objects: the organism prepares itself for further
encounters and more detailed relationships. The overall result is
increased alertness, more precise targeting, and higher quality image
processing.
In addition to providing a sense of knowing and an enhancement

of the object, images of knowing, supported by memory and
reasoning, form the basis for simple nonverbal inferences that
reinforce central conscious processing.
These inferences reveal, for example, the close link between the
regulation of life and the processing of images that is implicit in the
sense of individual perspective. Possession is hidden, as it were,
within the sense of perspective, ready to spring to the fore when the
following inference can be completed: If these images have the
perspective of this body that I now feel, then these images are in my
body, They are mine. As far as the meaning of the action is
concerned, it is contained in the fact that certain images are closely
related to certain options for the motor response. Hence our feeling
of being agents: these images are mine and I can act on the object
that caused them.
CONSCIOUSNESS FROM PERCEIVED OBJECTS AND REMEMBERING

PAST PERCEPTIONS
When objects appear in the mind not because they are

immediately present in our environment but because we retrieve
them from memory, their images also give rise to central awareness.
The reason has to do with the fact that
We store in memory not only aspects of the physical structure of an

object (the ability to reconstruct its shape, color, sound, characteristic
movement, smell, or whatever), but also aspects of the motor linkage
of our organism in the process. to apprehend those significant
aspects: our emotional reactions to the object, the general physical
and mental state at the time of apprehending the object. As a
consequence, the recall of an object and the display of its image in
the mind are accompanied by the reconstruction of at least some of
the images that represent those relevant aspects. Reconstructing this
collection of adjustments of the organism before the object that is
remembered generates a situation similar to the one that occurs when
we perceive an external object directly.6 The net result is that when
we think about an object, the reconstruction of part of the adjustments
that we need at the time to perceive it, as well as the emotional
responses we had to it, are enough to alter the proto-self in much
the same way that I have described when we are directly confronted
with an external object. The immediate source of the object to which
we become aware is different in present perception or memory, but
the awareness of apprehending something is the same, whether
perceived or remembered. Thus, Curarized patients, who are unable
to make somatomotor postural adjustments in order to perceive an
object, remain mentally aware of objects that appear on their stationary
sensing devices. In all likelihood, even plans for future perceptual-
motor adjustments will be effective modifiers of the protoser and thus
generators of second-order stories. If both one's own actions and
plans for those actions can be sources of second-order maps, then
central consciousness can emerge much earlier, since plans for
movement must necessarily come first.
of movements, just as the responses that end up causing emotions

occur before those emotions are expressed.
As our brain has the possibility of representing in somatosensory

maps the action plans and the actions themselves, and as such plans
can be available to second-order maps, the brain would have at its
disposal a double mechanism to build primordial narratives. of
consciousness.
THE NON-VERBAL NATURE OF CENTRAL CONSCIOUSNESS
Let me clarify what I mean by fabricating a narrative or telling a

story. Terms are so connected to language that I must ask again that
you do not think of this in relation to words. I do not mean narrative or
story in the sense of putting one word after another or spelling marks
in sentences or paragraphs. What I mean is telling a narrative or story
in the sense of creating a non-idiomatic map of logically linked events.
It is better to think of a film (although the film medium does not give
the perfect idea either) or a mime scene: Jean-Louis Barrault miming
the story of the robbery of the clock in Les enfants du Paradis. The
idea is captured in a line from a poem by John Ashbery: "This is the
melody but it has no words, the words are only a speculation (from the
Latin speculum)."7 In the case of humans, the non-verbal narration of
second order of consciousness can immediately become language.
We could call it the third order. In addition to the story that the act of
knowing entails and that ascribes it to the newly minted central
being, the human brain also generates an automatic verbal version of
the story. I have no way of stopping that verbal translation, and neither
do you. Everything that appears in the
Non-verbal lines of our mind are quickly translated into words and
phrases. That is in human nature, linguistic creature. This verbal
translation that cannot be inhibited, this fact that the knowing and the
central being also become verbally present in our minds at the
moment when we usually focus on them, is surely the source of the
notion that consciousness is given, and it only occurs when language
tells us about the mental situation. As I have already indicated above,
the idea of consciousness that this notion demands seems to indicate
that only humans with a substantial command of the language
instrument would come to have conscious states. Non-linguistic
animals and human babies would be left out.
This linguistic explanation of consciousness is unlikely and we

need to go beyond the mask of language to discover a more plausible
alternative. Interestingly, the very nature of language argues against
this idea that it plays a primary role in consciousness. Words and
phrases denote entities, actions, events, and relationships. Words
and phrases translate concepts and concepts consist of a non-
linguistic idea of what things, actions, events and relationships are.
Concepts necessarily precede words and phrases both in the
evolution of the species and in the daily experience of each and every
one of us. The words and phrases of healthy and sane humans do
not come from anywhere, they cannot be the ex novo translation of
anything. So when my mind says "I" it is translating, easily, effortlessly,
the non-linguistic concept of the organism that is mine, of the being
that is mine. If there were not a perpetually activated construct of the
central being, the mind could not translate it in any way as "I" or with
any other literary paraphrase that could be applicable to it in any
language that we could know. The central being must be there in
order to be translated into a suitable word.
In fact, it could be argued that the consistent content of the

verbal narration of consciousness, regardless of the extravagances
of its form, allows us to deduce the presence of a non-verbal
narration, in images, equally consistent with what I say is the
foundation. of consciousness.
The narration of the state of the protoser altered by the
relationship with an object must first be given in its non-linguistic form
if it is to be translated later into adequate words. In the sentence «I
see a car coming», the word I see represents an act of perceptive
apprehension carried out by my organism and that includes my being.
And the word I see is properly tied to the word I to translate the
wordless representation that is developing in my mind.
Let me now say that my views could be challenged in the

following way. What if that wordless representation of central
consciousness, the nonverbal narration of knowing, occurs below the
level of consciousness and only its verbal translation provides proof
that it occurs? The central consciousness could emerge only at that
moment of the verbal translation and not before, during the non-verbal
phase of the story. The point of view that seems to me less plausible
would be resorted to again, although with a slight change: the
mechanisms that I have outlined to describe the actors and the events
in the act of knowing would be maintained, but the possibility that the
narration alone nonverbal gave us access to know.
This alternative point of view would be interesting, but I am not

prepared to support it. The main reason for not supporting it comes
from the need to rely on the language and its ability to be able to have
a conscience. To begin with, although verbal translations cannot be
inhibited, they often slip by unnoticed and are uttered using a great
deal of literary license: the creative mind translates mental events in
a variety of ways rather than in a single stereotyped way. Furthermore,
the "linguistic" creative mind has
propensity to embark on fictions. Perhaps what is most revealing

about the human split-brain research is precisely this: that the left
cerebral hemisphere of humans is prone to fabricating verbal
narratives that are not necessarily in accord with the truth.8
It seems unlikely to me that consciousness depends on the

quirks of verbal translation and relies on the unpredictable level of
attention we pay to it. If consciousness depends on verbal translations
for its existence, it is most likely that we had different types of
consciousness, some sincere, others not; various levels and intensities
of consciousness, some effective and others not; and, worst of all,
lapses of consciousness. But that is not what happens in healthy
humans and in their judgment. The primordial story of being and
knowing is told seamlessly. Our degree of attention to the object
varies , but our general level of consciousness does not fall below a
threshold when we move from one object to another: we do not
remain in a stupor and do not appear to have a seizure; we are simply
aware of other things instead of not being aware of anything. The
threshold of consciousness is crossed when we wake up and then
consciousness continues until it turns off again. When we run out of
words and phrases we don't fall asleep: we just listen and observe.
I believe that the non-verbal and imagery narration of the central

consciousness is swift and that its unstudied details have long eluded
us, that the narration is hardly explicit, so half-insinuated that its
expression is almost the emanation of a belief. But some aspects of
the narrative seep into our minds to create the beginning of the
knowing mind and the beginnings of being. These aspects, captured
in the sensation of being and knowing, are the first to emerge above
the level of the sea of consciousness and precede the corresponding
verbal translation.
Requiring consciousness to depend on the presence of language

leaves no room for central consciousness as I have outlined it here.
Consciousness, according to the hypothesis of its dependence on
language, occurs after language dominance and therefore cannot
occur in organisms that lack language dominance. When Julian
Jaynes presents his suggestive thesis on the evolution of
consciousness, he is referring to consciousness after language, not
to central consciousness as I describe it. When thinkers as different
as Daniel Dennett, Humberto Maturana, and Francisco Varela speak
of consciousness, they usually refer to consciousness as a
postlinguistic phenomenon. To me , they speak about the higher
realms of expanded consciousness as it exists now, in the present
state of biological evolution. it rides on the basic core consciousness
that we and other species have had for a long time and continue to
have.
THE NATURALITY OF NARRATIVE WITHOUT WORDS
The wordless narration is natural. The iconic representation of

sequences of brain events, which occurs in brains simpler than ours,
is the stuff of which stories are made. The reason we've ended up
creating tragedies and, ultimately, books, and why so much of
humanity is so hooked on movies and television, may be that
preverbal storytelling naturally occurs. Movies are the most similar
external representation to the predominant narration that occurs in
our minds. What happens in each shot, the different framing of a
character that the movement of the camera can give us, what happens
in the transition between the different shots and what is achieved in
the montage, as well as what happens in the constructed narrative
through a juxtaposition
The concrete set of scenes is comparable in some respects to what

goes on in the mind, thanks to the machinery that takes care of
fabricating visual and auditory images and devices such as the many
levels of attention and working memory.
Be that as it may, the wonder consists in thinking that the very
first brains that constructed the story of consciousness were answering
in doing so questions that no living being had ever asked: Who makes
these images that have just occurred? Who do they belong to?
"Who's there?" as in the poignant opening line of Hamlet, a play that
so powerfully epitomizes the bewilderment of humans at the origins
of their condition.10 The answers had to come first, by which I mean
that the organism first had to construct the kind of knowledge that has
the aspect of response. The organism had to be able to produce this
primordial, unsolicited knowledge in such a way that the process of
knowing could be founded.
The complete construction of knowledge, from the simple to the

complex, from nonverbal imagery to literary verbality, depends on the
ability to represent what happens over time within our organism,
around our organism, with our organism and our organism, thing
after thing, causing a new thing, endlessly.
Storytelling, in the sense of recording what happens in the form

of brain maps, is probably a cerebral obsession and probably starts
quite early in evolution and in relation to the complexity of the neural
structures required to create narratives. Telling precedes language
since it is, in fact, a condition for language and is based not only on
the cerebral cortex but on other parts of the brain and on both the
right and left hemispheres.11 Philosophers are often puzzled about
with the problem called "intentionality," that intriguing fact that mental
contents "refer to" things that are outside
of the mind. I believe that the pervasive "reference" of the mind is

rooted in the reporting attitude of the brain. The brain inherently
represents the structures and states of the organism, and in the
course of regulating the organism that it absolutely must do, the brain
naturally weaves stories about what happens to an organism that is
immersed in an environment.
A FINAL WORD ON THE HOMUNCUS
At this point a comment on the infamous homunculus solution to

the problem of being and the reason for its failure comes in handy.
The disqualified solution of the homunculus was to postulate that a
part of the brain, "the knowing part", possessed the necessary
knowledge to interpret the images that were formed in that brain.
Images were presented to the knower and that knower knew what to
do with them. In this solution, the knower was a spatially defined
continent, the so-called homunculus. The term suggested the image
that many people had of his physical structure: a little man scaled
down to the limits of brain size. Some even imagined that the
homunculus looked like a textbook drawing of the motor and
somatosensory regions of the cerebral cortex, with its tongue out and
feet up.
The difficulty of the homunculus solution was that this little person
who knew everything provided us with knowledge but then faced the
difficulty of who provided his.
Who gave him his knowledge? Well, of course, another little person,
only smaller. In turn, the second little person would need a third little
person inside him who would be his knower. The chain would be
endless, and this postponing the difficulty, a ruse known as infinite
regress, effectively ruled out the homunculus solution. This
disqualification was good, from
then, with regard to his emphasis on the inadequacy of a traditional

brain "center" to explain something as complex as knowing. But it
had a chilling effect on the development of alternative solutions. It
created a fear of the homunculus worse than the fear of flying and
that ended up becoming the fear of specifying a knowing being,
cognitively and neuroanatomically speaking. To put it briefly, the act
of knowing and being went from being in a little person in the brain to
being nowhere.
The failure of the homunculus idea to provide a solution to how

we know cast doubt on the very notion of being. Unfortunately. We
should naturally be skeptical of a knower of the little man type, clothed
in all knowledge and located in a single, concrete part of the brain.
Physiologically it makes no sense. All the available evidence seems

to suggest that there is no such thing. However, the failure of the little-
man-like knower does not seem to indicate that the notion of being
should or can be discarded along with that of the homunculus.
Whether we like that notion or not, in the normal human mind there is
such a thing as a sense of being as we go about knowing things.
Whether we like it or not, the human mind is constantly divided, like a
divided house, between the part that represents what is known and
the part that represents the knower.
The story contained in the images of the central consciousness
is not told by an intelligent homunculus. Nor is it that we as beings
tell ourselves that story, since that central us is only born when the
story is told within the story itself.
We exist as mental beings when the primordial stories are told and
only then; as long as those primordial stories continue to be told, and
only as long as they continue to be told.
We are the music while the music lasts.
Brains equipped with the appropriate devices, in addition to the
well-known sensory and motor devices, can form images of the
organism caught at the moment of
forming images of other things and reacting to such images. These

extra devices allow the act of knowing in an organism previously
equipped with the capacity to represent a stable proto-being and to
represent a whole host of things that can happen to it within the body
or to the body itself.
There is no homunculus involved in this matter. There is no regress
of any kind, neither infinite nor non-infinite. In the homunculus knower-
based version of consciousness, a special knowing agent is asked to
please explain what is going on; the knowing neural and mental
homunculus must know more than the brain and mind it serves. But
naturally, then comes the next knowledgeable homunculus who must
know more than the previous one and so we continue ad infinitum
and ad absurdum. In my proposal there is no need to interrogate
any agent, any connoisseur. Moment after moment, the response is
presented to the organism, as represented by the protoser, placing it
before it in the form of a nonverbal narrative that can then be
translated into language. The explanation is presented before it is
requested.
The protoser is a reference rather than a store of knowledge or

an intelligent perceiver. Participate in the process of getting to know,
patiently waiting for the most generous to explain what is happening
by asking those questions that have never been asked before: Who
does it? Who knows?
When the answer comes earlier, the sense emerges of already being
us, at this moment, creatures endowed with abundant knowledge and
autobiographical being, millions of years after the first examples of
primordial stories appeared, we get the impression that the question
was raised, that the being is a knower who knows.
So no questions. There is no need to question the central being

about the situation nor does the central being interpret anything.
Knowledge is offered generously and freely, at no cost.
INVENTORY
I have been proposing the idea that the central consciousness

depends on an image incessantly originated from the act of knowing,
expressed first as a sensation of knowing in relation to the mental
images of the object to be known; and I have also advanced the idea
that the sense of knowing results in, and is accompanied by, an
enhancement of the images of the object.
Looking now at the possible biology behind the central

consciousness, I put forward a set of neural structures and functions
that could support the emergence of the sense of being and knowing.
That proposal of mine, presented in the form of a hypothesis, was
intended to fulfill outlined requirements for the biological role of
consciousness and for the description of its mental appearance, as
well as to conform to the known facts of neuroanatomy and
neurophysiology. The hypothesis states that central consciousness
occurs when the brain forms a second-order, nonverbal, imagery
account of how the body is causally affected by processing an object.
The story in images is based on second-order neural patterns
generated from structures capable of receiving signals from other
maps that represent both the organism (the protoser) and the object.12
The composition of the second-order neural pattern that describes

the object-organism relationship modulates the neural patterns that
describe the object and leads to enhancement of the image of the
object. The encompassing sense of being in the act of knowing an
object arises from the contents of the picture story and from the
enhancement of the object, presumably in the form of a large-scale
pattern that combines both components coherently.
The neuroanatomical structures required by the hypothesis
include those that support the protoser, those necessary to process
the object and those necessary to generate the story in images of the
relationship and produce its consequences.
The neuroanatomy underlying the processes hidden behind the

protoself and the object (provided in Chapter 5) includes the brainstem
nuclei, the hypothalamus, and the somatosensory cortices. The
neuroanatomy underlying the imagery of object relationship and
image enhancement (presented at the beginning of this chapter)
involves the cingulate cortices, thalamus, and superior colliculus. The
consequent image enhancement is achieved through modulation of
the acetylcholine and monoamine nuclei of the basal forebrain and
brainstem, as well as through thalamocortical modulation.
Figure 6.3. Combination of the main structures of the protoser and second order
maps. Note that most of these structures are located near the midline of the brain.
To conclude: in its normal and optimal functioning, central

consciousness is the process of achieving a neural and mental
pattern that brings together, at approximately the same instant, the
pattern of the object, the pattern of the organism, and the pattern of
the relationship between the two. The emergence of each of these
patterns and their temporal conjunction depends on the contributions
of the individual brain sites that work closely together, and in the
proposal that I have made in this chapter I address one aspect of the
overall process, the relative to the construction of relationship patterns
between organism and object.
By the time the great central consciousness pattern emerges,
there are already several localized brain regions that have succeeded
in recruiting much of the brain tissue into action. Just in case the
scale of this operation strikes you as impressive, consider next that
the great pattern of central consciousness is next to nothing, to say
nothing, compared to the even greater pattern of expanded
consciousness, at the same time. which I will dedicate in the next
chapter. Just as William James might have wished, almost the entire
brain is engaged in the conscious state.
CHAPTER SEVEN
EXPANDED CONSCIOUSNESS
EXPANDED CONSCIOUSNESS
If the central consciousness is the indispensable foundation of

consciousness, the expanded consciousness is its summit. When we
think of the greatness of consciousness, what we have in mind is
expanded consciousness. When we mislead ourselves and say that
consciousness is a distinctively human quality, what we have in mind
is heightened consciousness in its greatest capacities and not core
consciousness, although the arrogance should be forgiven us:
heightened consciousness is indeed a prodigious function. and at its
best it is uniquely human.
Expanded awareness goes beyond the here and now of core

awareness, both forwards and backwards. The here and now is still
there but flanked by the past, in whatever quantity we need to
illuminate the now effectively and, just as importantly, also flanked by
the envisioned future. The scope of expanded consciousness, at its
zenith, can encompass the individual's entire life, from cradle to
future, and can lay the world at their feet. On any given day, just by
letting it fly, expanded consciousness can make us characters in an
epic novel, and just by using it well, it can throw the doors of creation
wide open for us.
The expanded consciousness is everything that the central

consciousness is, only more and better, and it does nothing but
increase in the course of evolution and the life of experiences of each individual.
If central awareness allows us to know for a fleeting moment that
what we see is a bird in flight or that we are experiencing a sensation
of pain, expanded awareness places those same experiences on a
larger canvas and over a longer period of time. . The expanded
consciousness still gravitates to the same center, the "me," but that
"me" is now connected to the lived past and anticipated future that
are part of our autobiographical record. Instead of just accessing the
fact that we are in pain, we can also review the facts about where the
pain was (the elbow), what caused it (tennis), the last time we had it
(three years ago? or four?), who recently had it (Aunt Marga), which
doctor did you go to (Dr. May, or was it Dr. Nichols?), the fact that we
won't be able to play with Juan tomorrow. The range of knowledge
that expanded consciousness now allows us encompasses a wide
panorama. The being that is perceived in this wide landscape is a
strong concept in the strict sense of the word. It is an autobiographical
being.
Being autobiographical pivots on the consistent reactivation and

display of selected sets of autobiographical memories. In the central
consciousness, the sense of being arises in the subtle and fleeting
sense of knowing, built anew with each pulse. In contrast, in expanded
consciousness, the sense of being arises from the consistent and
reiterated display of some of our personal memories, objects from
our personal past, those that can easily be the substance of our
moment-to-moment identity and our be people.
The secret of expanded consciousness is revealed in this

organization: autobiographical memories are objects and the brain
treats them as such, allowing each of them to relate to the organism
in the way described for consciousness.
central and therefore allows each of them to generate a pulse of

central consciousness, a feeling of being knowing. In other words,
expanded awareness is the precious consequence of two enabling
contributions: first, the ability to learn and thereby retain records of
myriad experiences, previously known through the potency of central
awareness. Second, the ability to reactivate these registers in such a
way that, as objects, they can in turn generate a "sensation of being
knowing" and, therefore, be known.
As we move, biologically speaking, from the simple level of

central consciousness, with its generic sense of self, to the complex
levels of expanded consciousness, the most salient physiological
novelty is factual memory. As a primordial trick, it consists of more of
the same: multiple generations of a simple “feeling of being knowing”
applied both to that something to be known and to that something to
which knowledge is attributed, complex and eternally revived: the
autobiographical being. The final enabling factor is working memory,
the ability to keep active, for a substantial amount of time, the many
"objects" of the moment: the object being known and the objects
whose display constitutes the autobiographical self. The time scale is
no longer the fraction of a second that characterizes central
consciousness. We are now on the scale of seconds and minutes,
the time scale on which most of our lives take place and which can
easily be extended to days and years.
In short, the expanded consciousness emerges from two tricks.

The first requires a gradual construction of memories of many kinds
of a special class of objects: the "objects" of the biography of the
organism, of our own life experience, as they have unfolded in our
past, illuminated by the central consciousness. Once autobiographical
memories are formed, they can be used again when any object is
processed. Every one of those memories
Autobiographical stories are then treated as objects in the brain, each

one of them becoming an inducer of central consciousness, together
with that specific object that is not the being and that is being
processed. Just as it relies on the same fundamental mechanism of
central consciousness (the creation of mapped accounts of ongoing
relationships between organism and objects), extended consciousness
applies the mechanism not just to a single object X that is not the
being, but to a consistent set of previously memorized objects that
belong to the history of the organism, whose incessant recapitulation
is coherently illuminated by the central consciousness and constitutes
the autobiographical being.
The second trick is to keep active, simultaneously and for a

substantial time, the many images whose collection defines the
autobiographical being and the images that define the object. The
repeated components of the autobiographical self and the object are
bathed in the sense of knowing that arises from the central
consciousness.
Therefore, expanded consciousness is the ability to be aware of
a wide range of entities and events, that is, the ability to generate a
sense of individual perspective, to be possessors and to be agents,
over a larger range of knowledge than the one explored. by the core
consciousness. The sense of being autobiographical to which this
larger scope of knowledge is attributed encompasses unique
biographical information.
Autobiographical beings only occur in organisms endowed with
substantial memory capacity and reasoning ability, but they do not
require the presence of language. Evolutionary psychologists such
as Jerome Kagan have suggested that humans develop a "self" when
they are eighteen months old, or even earlier. I believe that the self
they are referring to is the autobiographical self.1 I also believe that
monkeys, like bonobo chimpanzees, have an autobiographical self,
and I would venture to say that the same is true of some dogs I know.
They have a being
autobiographical but not a total person. You and I have both, of

course, thanks to a larger endowment of memory, reasoning ability,
and that fundamental gift called language. Over evolutionary time, as
well as over individual time, our autobiographical selves have allowed
us to learn more and more complex aspects of the organism's physical
and social environment, as well as the organism's place and potential
for action in a world. complicated universe.
Expanded consciousness is not the same as intelligence.

Extended consciousness has to do with the organism's awareness of
the larger realm of knowledge, while intelligence corresponds to the
ability to manipulate knowledge in such a successful way that new
responses can be planned and implemented. Amplified consciousness
has to do with the display of knowledge and its clear and efficient
display in such a way that intelligent processing can take place.
Expanded awareness is a prerequisite for intelligence: how would we
behave intelligently over vast domains of knowledge if we couldn't
explore such knowledge with expanded awareness?
Extended consciousness is also not the same as working

memory, although working memory is an important tool in the process
of extended consciousness. Expanded consciousness depends on
the holding in mind, for a substantial time, of multiple thought patterns
that describe the autobiographical self; and precisely working memory
is the ability to hold images in the mind long enough for them to be
intelligently manipulated. To get an idea of what working memory is,
let's think about how hard it is to keep in your head, without the help
of a pen and paper, a ten-digit phone number, or detailed directions
on how to get to a certain place. We can also test our working
memory: we should be able to hold a seven-digit number in our heads
long enough.
long enough to be able to enumerate without error, from back to

front, the last three or four digits.2 A large working memory is
also a prerequisite for expanded consciousness, so that multiple
representations can be held in mind for a long period of time. of
time. On the contrary, and as far as central consciousness is
concerned, the role of working memory seems negligible. The
notion of "global workspace" developed by psychologist Bernard
Baars is a good way to describe the conditions under which
certain abilities, such as working memory and focused attention,
contribute to expanded consciousness.3
Table 7.1. kinds of being
The arrow between the non-conscious proto-self and the conscious core self
represents the transformation that occurs as a result of the core consciousness
mechanism. The arrow to autobiographical memory indicates the memorization of repeated instances of
core self experiences. The two arrows toward the autobiographical self signify its
dual dependence on both continuous pulses of central consciousness and
continuous reactivations of autobiographical memories.
Central consciousness is part of the standard equipment of complex

organisms like ours; it is in place thanks to the genome, with a little help
from the first environment in which we developed. Culture may be able
to modify it to some extent, but probably not too much. Extended
consciousness is also transmitted by the genome, but culture can
significantly influence its development within each individual.
Expanded Consciousness Assessment
The expanded consciousness relies on the core consciousness not

only for its development over time but moment by moment. The study of
neurological patients shows that when the central consciousness is
eliminated, the expanded consciousness goes. As we have seen,
patients with absence seizures, epileptic automatisms, akinetic mutism,
and persistent vegetative state have neither central consciousness nor
expanded consciousness. The reverse is not true: as we will see in the
following pages, damage to extended consciousness is compatible with
preservation of core consciousness. Expanded consciousness is a larger
issue than central consciousness and is easier to deal with scientifically.
We understand quite well what it is cognitively speaking, and we also
understand its corresponding behavioral traits. An organism in possession
of expanded consciousness exhibits attention across a wide range of
information present not only in the external environment but also
internally, in the mental environment. For example, as a possessor of
expanded consciousness, you are surely paying attention to a number
of different mental contents simultaneously: the printed text, the ideas
that
it evokes, to the questions that it provokes, perhaps to a specific music

or noise that you have at home and to yourself as a being that you know.
Not all of this content is equally relevant or defined with the same
precision, but all of it is on stage and at one time or another, for seconds
or even minutes, comes to the fore.
The organism with expanded consciousness shows signs of

planning complicated behaviors not only in the present moment but for
longer intervals of time: hours, days, weeks and months. An observer
can infer that such complex and appropriate behaviors have been
planned taking into account the history of the individual and the context
in which he was immersed. In other words, what a person does has to
make sense not only in terms of immediacy but also in contexts on a
much larger scale.
The work of Hans Kummer with baboons and Marc Hauser with
chimpanzees seem to indicate that what I am describing as extended
consciousness is found in non-human species. Kummer's painstaking
fieldwork and Hauser's ingenious laboratory experiments reveal
behaviors that require those cognitive operations described above. One
example is the complex and laborious decision-making behavior of a
herd of baboons to choose where to drink on a given day. The decision
comes up against numerous difficulties, for example the estimated
presence of water in a certain watering hole, the risk of encountering
predators, the distance and so on. The evidence seems to indicate that
all of these factors are recognized and related to the homeostatic needs
of individuals.4
Extended consciousness is necessary for the internal display in the

various sensory systems and modes of a substantial amount of
remembered knowledge, as well as for the consequent abilities to
manipulate such knowledge in solving or reporting a problem. The
execution
habitual use of these skills demonstrates the presence of extended

knowledge. Assessment of extended consciousness can be achieved
by assessing recognition, recall, working memory, emotion and
feeling, reasoning, and decision making over long time intervals in an
individual whose central consciousness is intact.
In a neurologically normal state, we are never completely

deprived of expanded consciousness. However, it is not difficult to
imagine what the possessor of only central consciousness is likely to
experience. Just consider what it can be like to be inside the mind of
a one-year-old. I suspect that objects come to the fore of the mind,
are attributed to the central being, and leave as quickly as they enter.
Each of the objects is known by a simple and clear being in itself, but
there is no large-scale relationship between objects in space and time
and no sensible connection between object and past or anticipated
experiences. In the pages that follow, we will see that this assumption
can be supported by analyzes of what occurs in neurological
disorders. As usually happens in the case of mental matters, neurology
allows itself its own approach to the problem.
DISORDERS OF EXPANDED CONSCIOUSNESS
Just as loss of central consciousness leads to loss of extended

consciousness, the reverse is not true. Patients in whom expanded
consciousness is threatened retain central consciousness in one way
or another. Thus, the precedence of the central consciousness is
firmly established.
transient global amnesia

The most striking examples of impaired expanded consciousness

occur acutely and dramatically in a condition known as transient
global amnesia. It is a benign disease in the sense that patients end
up returning to normal. Transient global amnesia can occur with
migraines, sometimes as a prodrome to headache, sometimes as a
substitute for it. In transient global amnesia, beginning acutely and
lasting a few hours, usually less than a day, a completely normal
person is suddenly deprived of newly added records of autobiographical
memory. The mind no longer has anything that happened moments
before, or in previous minutes or hours. On some occasions, nothing
of what happened in the days prior to the onset of amnesia is available.
Taking into account that our memory of the here and now also
includes memories of the events that we are constantly anticipating
(what I like to call memories of the future), it follows that the person
suffering from transient global amnesia does not have any memory
that he has to do with the plans for the minutes, hours or days ahead.
For the transient global anesthetic, it is quite common to have no idea
what the future may hold. Thus, the person affected by transient
global amnesia is deprived of both his own historical origin and his
personal future, although he does retain the central consciousness
for the events and objects of the here and now. In effect, when a
patient is unable to recognize a particular object or person, he or she
still has a central awareness of the fact that he or she no longer has
a certain knowledge. However, despite adequate awareness for
current objects and actions, the situation does not make sense to the
patient because, without an updated autobiography, the here and
now is simply incomprehensible. The predicament that transient
global amnesia produces underscores the significant limitations of
central consciousness: without the antecedents to account for the
current location of objects and the reason for current actions, the
present is nothing more than a puzzle. Which is surely why, almost
invariably, transient global amnesiacs constantly repeat the same
anguished questions: Where am I? What am I doing here? How did I
get here? What am I supposed to do? Patients don't usually ask who
they are. They often have a basic sense of self, though even that
sense is impoverished. If patients with epileptic automatism are good
examples of the suspension of central consciousness and everything
that pivots on it (being central, being autobiographical, expanded
consciousness), patients with transient global amnesia are the perfect
example of expanded consciousness and autobiographical being in
suspense, with central consciousness and central being preserved.
A few years ago we had the opportunity to study a patient with

the mildest episode of transient amnesia that we had come across,
and I would like to tell you about it. The patient was a highly intelligent
and highly educated woman who had a brilliant profession as an
editor. He had a long history of migraines and was otherwise in
excellent health. About nine months before being admitted to our
service, she began to have the classic migraine pains, sometimes
with visual disturbances in one of the visual semifields and, from time
to time, with linguistic difficulties. The headaches had become
frequent, one a week. Two weeks before admission, on a routine visit
to her family doctor, she complained of headaches and was referred
to our headache clinic with the recommendation that she keep a
detailed record of the onset, course, and possible reasons for each
of your headaches.
Prior to the episode described below, he had recorded the details of

four different headache episodes at the time they occurred. Finally,
he experienced
"rare event" which he reported as follows, written in very clear

handwriting, at the same time as his symptoms were given.
Here is his report without corrections.5
Thursday, Aug 6, 11:05. On my desk. Suddenly a rare episode. I feel like I'm
going to pass out or get sick. Clear vision, but my whole being is focused on
the rare episode. I lean back. I close my eyes. I concentrate so as not to get
sick (I think about going to the bathroom, I decide not to, I prefer to continue
sitting). I never lose awareness of my surroundings but I am strangely centered
in myself and in that strange feeling (I never lose the sense of where I am or
the sounds). When I finish I feel hot, I ask my office colleague something about
the heating (now, five minutes later, I don't remember what I said), she tells me
that it's fine (I think). I feel good now. It's 11:08. But I'm not well focused on
what I do.
I look at my work. I don't recognize the page of the manuscript I'm correcting!
I open it later, further back, but I can't remember exactly what I was doing. (I
have the general idea clear but not the page I am on or what I was doing.)
Looking through the diary to record this "event," I find names of people I've
dealt with in the last ten days who disturb me: I'm not sure who they are. Still,
most of the annotations are clear to me.
11:23. Reading again. I remember starting to write this but I can't recognize
the first few lines! My head is pretty clear now but I'm still a bit confused as to
what, if anything, this I just experienced means. At this moment my head is
clear and fine, maybe a little heavy (I think if it will be a headache but no). I
dare not look at my work to see if it makes any more sense than it did ten
minutes ago.
11:25. I reread what I wrote at the top of the first page: I don't recognize the
terms I used! I remember starting to write this but I am interested in the fact
that the beginning seems strange.
11:30. Clear head still. No headache. Good vision. Now I try to remember
the significant circumstances that I must record. Running morning. I had a
coffee at 10 am I have been reading and correcting a manuscript all morning. I
haven't left the table since I had coffee.
Every time I read something I've written, I find statements that are confusing
because I don't remember writing them. Trivial terms but still they confuse me
because I don't recognize them. (Note: all the time I am sure of what I am, who
I am, where I am and what I am doing here.)
11:35. I play classical music on the radio.

11:45. When I first looked at the agenda to write down this episode I discovered that I was
confused by a couple of names that I could see. The truth is that that was the reason to start writing
all this. Now, a half hour later, those names still confuse me (!). I've looked them up in my
department directory and can identify them and what I did with them, but I'm still worried the names
are weird.
The entry “entry of the two reports on infection control” for August 3 remains unclear. (I don't
remember what it's about and we're only August 6th.)
11:50. I think I remember doing the reports, but I still can't focus on their content. "Infection
control"?
11:55. I've remembered where to look to confirm who those names are (but I still don't know
what reports I've prepared for them). I'm going to
to eat.
12:05. On the way out I went to the bathroom and then I stopped by to reread this and wonder
about its importance, apart from having been a passing episode of I don't know what. I go out to
eat. My head is a bit heavy.
1:00. I got to eat well. Unsure of the identity of old friends in the lobby. But the conversation is
fine. I got in line and had a moment of panic about how to sign, then I remembered. Just in case, I
took a look at what the person in front of me was writing on the card. I started my social security
number and panicked before I finished typing it, I guess correctly. I had a healthy meal, tuna salad,
milk. I sat alone. I dawdled for a bit, wondering what this episode would mean and if I should let
someone know right away.
Go home to rest? forget it?

1:20. I've poured myself a coffee and get back to work. I have decided to do nothing. I feel quite
stable, without problems and quite sure of what I'm doing (although a little scared). I get a coffee. I
play nice music on the radio, I still feel insecure, aware of the pulse (I take it: 80).
2:05. Working hard, especially checking the work in the morning.

I feel quite normal.
4:15. I feel quite normal. I take a little walk at 4 pm to the library and browse. I haven't tried to
read since 1:20 pm or test my recollection of matters that were unclear to me before.
5:45. Before I go home, I look at the diary again and realize that I had mistakenly read the
entries from other days before! Now it makes sense and I remember the reports I worked on and
the people associated with them. I also remember looking at these entries this afternoon and each
time I read them they seemed different (!). No physical incoordination.
Aug 7, 10:05 am I wake up fine. Well late, with a somewhat heavy head,
anxious, I talk to X... who says if it will not be a drop in sugar.
I eat two slices of walnut bread, a good piece of cheese, orange juice,
decaffeinated and 1/2 teaspoon of sugar. I went to work. At 9:00 am I start to
notice a headache behind my eyes (and notice that I'm sweating). 9:30: I'm
sure: I have a cup of coffee with two teaspoons of sugar and one more directly.
Now, at 10:00 am, head almost clear, but still heavy.
I've been on the phone to talk about work. I have discussed work with
several people. Fine, but she may have been slower than usual when speaking.
Do I look for the words? Stop.
1:25. Then I got the headache again. I had lunch at 12:00. My head never
stopped hurting. Although it is mostly located behind the eyes, this time it is the
left eye and the left temple, and from there it radiates back and down.
Aug 10, 4:30 pm Have a nice weekend. Today is also a good day.
This unique report was made possible by a number of fortunate

circumstances. First, the crisis was mild and the patient was less
anxious than usual. Second, her doctor had instructed her to write
down the precise circumstances in which her head ached and so she
felt compelled to write a detailed report of any events that were related
to it. Finally, it was about an intelligent and educated woman who had
a preparation, by her personality and her professional training, to offer
a convincing exposition of her experiences.
The central consciousness process was maintained throughout

the crisis, thus allowing him to organize his thoughts and behave with
almost complete coherence. If we had been witnesses of the event
and had been associated with her, I daresay we would have noticed
something different in her manner, perhaps concern, perhaps
vagueness, surely both. But we would certainly have seen her alert,
with sustained and focused attention, with sustained and appropriate
demeanor, and recognizably motivated emotionality. There would
have been no resemblance even remotely to the zombie-like behavior
of an epileptic
during a crisis of automatism. This is important because the acuteness

and transience of crises often lead us to group the two diseases
unacceptably. Transient global amnesia and automatism epilepticus
are as different as night and day.
The temporary impoverishment of this patient's autobiographical

self, even as mildly as she was fortunate enough to experience it,
was the dominant manifestation of her illness. Of course, there was
the remote biography, but the period of time immediately before the
disturbance had been lost, and even the events of previous days
came to light in a kind of twilight. The diminished availability of
biographical information, which was so dramatic for recent personal
experiences, was even distinguishable in the weak retrieval of
information about his own identity. Unable to retrieve her name for an
instant, she nearly panicked.
The drama of a day of transient global amnesia is often reduced

to a matter of less than an hour in post-traumatic amnesia. Post-
traumatic amnesia is a common consequence of severe head injuries.
A recent patient has provided an insightful report. DT was thrown by
his horse, causing him to fall on his back and immediately lose
consciousness. The observers who rushed to help him estimated that
he had been unconscious for almost ten minutes. By the time first aid
arrived DT had regained consciousness; he seemed confused and
somewhat agitated and kept asking what was going on. His
recollection of the event begins at about these times and he recalls
the development of a clear sequence of states. At first, he looked at
the faces above him and couldn't understand who they were or why
they were looking at him.
She also had no clear idea who he was, much less who he was.
what was he doing on the floor Then some idea of who he was came
to mind, although the situation remained inexplicable. A moment later,
perhaps after noticing that he was wearing his sports clothes, he said
he wanted to go for a run; that of course that had been his intention
before having to face that so surly horse that had been responsible
for all that mess. It was only when she was in the ambulance and on
the way to the hospital that she began to regain some sense of her
identity.
In less than an hour, DT went through a variety of neurological
diseases. First, an illness not unlike coma or deep dreamless sleep
or general anesthesia, in which all forms of consciousness, attention,
and wakefulness were suspended. Second, another in which he
regained wakefulness and minimal attention but still lacked central
consciousness, something not very different from certain states of
akinetic mutism or epileptic automatism. Third, a situation not unlike
transient global amnesia, in which central consciousness had returned
but extended consciousness was not yet present. He finally had the
full array of his abilities at his disposal again.
Extended consciousness is also disturbed throughout the

progression of Alzheimer's disease. When memory loss of past
events is significant enough to compromise autobiographical records,
the autobiographical self gradually dies out and extended
consciousness is depleted. Which occurs before the subsequent
collapse of central consciousness that I presented in chapter 3. An
event that occurred with the patient and friend that I described on
page 112 illustrates this problem.
The patient was sitting quietly when he saw his wife walking
towards him. He gave no sign of recognizing her but returned her
affectionate smile with another. Knowing he wouldn't recognize her,
she said in her soft voice not only "good morning" but also "I'm your
wife." To which he replied for the first time in
the course of his illness: «And who am I?». The question was serious,
prosaic. No trace of humor or anxiety. That inquisitive streak of his
former autobiographical self was still there, a sturdy vestige, and he
simply wanted to know.
The disease had passed from the state in which the learning of
new facts and the retrieval of general memories was no longer
possible to the state in which the personal biography could no longer
be reliably displayed. The autobiographical self and the expanded
consciousness that depends on it were gone forever. Months later it
would also be the turn of the central consciousness and its simple
sense of being.
anosognosia
Anosognosia provides another good example of impaired

heightened consciousness without central consciousness being
affected. The word anosognosia derives from the Greek nosos,
"evil", and gnosis, "knowledge", and indicates the inability to
recognize a diseased state in the body itself. Let's not worry that the
word should have been "nosoagnosia" instead of anosognosia to
follow tradition: think of prosopagnosia and simultagnosia; the term
has prevailed.
Neurology is not without its quirky diseases, but anosognosia is
one of the rarest. The classic example of anosognosia is that of a
seizure victim who is completely paralyzed on the left side of the
body, unable to move hand and arm, leg and foot, unable to stand or
walk, and remains unaware of his or her condition. and who says that
nothing of that.
When asked how they feel, these anosognosia patients respond with
a sincere "I'm fine." This shocking disease was first described by
Babinski in the early 20th century.6
Fans of "psychological" explanations have believed that this

denial of illness is psychodynamically motivated and is nothing more
than an adaptive reaction to the enormous problem facing the patient,
colored by the patient's past history in relation to other such situations. .
They are wrong. It can easily be assumed that this is not the case in
view of the mirror situation cited, namely that of the patient who has
the right side affected instead of the left. These patients do not
develop anosognosia. They may be severely paralyzed and even
severely aphasic, and yet they are perfectly aware of their tragedy.
Anosognosia occurs when the right hemisphere is damaged.
Interestingly, some patients in whom the left-sided paralysis is caused
by a pattern of brain injury other than that causing anosognosia may
be cognizant of their disease. In short, anosognosia systematically
occurs when there is damage to a certain region of the brain and only
to that region. The denial of the disease is caused by the loss of a
specific cognitive function, and the cognitive function depends on a
specific brain system that is damaged by the neurological disease.
The presentation of anosognosia is quite typical. My patient DJ

had complete paralysis on the left side, but when I asked him about
his left arm, he began by telling me that it was fine, that maybe it had
been bad once, but not anymore. When I asked her to move it, she
reached for it, and confronting his limp member, she asked me if I
"really" wanted her to "move it." Only then, and as a result of my
insistence, did he admit that he "didn't seem to move on his own."
Invariably, she would then take it with her right hand and state the
obvious: "I can move it with my right hand."
This inability to notice the defect quickly and automatically, as

well as internally, through the body's own sensory system is
astounding, while the inability to
knowing the defect after repeated confrontation is even more so.

Gradually, some patients can remember many confrontations with
that situation and rely on this "externally" obtained information to
come to say that they have had a problem even though they continue
to have it.7 Patients with anosognosia have a lesion in the right
hemisphere, in a region which includes the insular cortex,
cytoarchitectural areas 3, 1, 2 of the parietal region and area S2 ,
also parietal, located deep in the Sylvian fissure. The damage affects
the white matter
connections
below to
those
the thalamus,
regions, disrupting
basal ganglia,
its interfacing
and prefrontal
and
and motor cortices.
When only parts of this multicomponent system are damaged,

anosognosia does not occur. (See the figures in the appendix, section
2.)
The brain areas that intersect signals with the entire region of
the right hemisphere damaged in anosognosia surely produce,
through their conjugate interactions, the most complete and integrated
map of the current state of the body that the brain can have.8 I have
indicated that Anosognosia fundamentally results from the inability to
represent bodily states automatically and through the appropriate
signaling channels, which are those of the somatosensory system.
More or less, this is the most common explanation of the disease.9
But while the traditional explanation may well serve to clarify the main
source of the problem, we also need to explain why after patients are
told directly that they are paralyzed they continue to be paralyzed.
without remembering a statement of such importance after a few
minutes. And why even when they have seen that they are paralyzed
and agree that they are not able to move their limbs on the left side in
the same way as those on the right side, they also do not remember
these obvious facts when asked after Little time. For
To explain that aspect of anosognosia that allows someone to hold

such a patently false belief despite receiving contrary information, we
need to invoke something more complicated than mere lack of
somatosensory actualization. My suggestion is that such disruption of
the right hemisphere somatosensory maps targets directly at the heart
of the organism's highest level of integrated representation and, in
doing so, undermines part of the biological foundation of the protoser.
The highest level of representation of the current state of the organism
is then no longer complete and is therefore not available for use in
the second-order account of the organism-object relationship, on
which consciousness depends. Second-order stories can still be
created from changes in the representation of the proto-self at lower
levels, such as in the brain stem. As a consequence, central
consciousness is not affected. But the central being that emerges
from it can no longer contribute anything to autobiographical memory
because that contribution to autobiographical memory surely requires
that part of the protoser that is produced in the right-sided
somatosensory cortices.
This interpretation is only sustained if we remember that the

representations of the body occur at various levels, from the brain
stem to the cerebral cortex, and that their respective contributions
vary from level to level. The lower (brain stem) inputs are essential
for the maintenance of central consciousness; other inputs are
ineffective when brainstem inputs fail.
In all likelihood, the higher inputs (those from the cortex) are absolutely
necessary to form memories of recent changes in the body and to
update the bodily component of autobiographical memory.
The lesions caused by anosognosia do not destroy all

representations of the organism. They only destroy the set of
representations that combine, in the greatest detail, the musculoskeletal
framework and the state of the internal environment and of the organs.
The highest level at which such conjugation can occur is the set of
somatosensory maps located in the insula and in areas S2 and S1 of
the right cerebral hemisphere. In anosognosia a number of important
representations of the organism remain intact. Among them, those of
the homologues of the right insula and of the S2 and S1 areas in the
left cerebral hemisphere; those of the pons and midbrain brainstem
nuclei and that of the hypothalamus. All these representations
together provide a partial picture of the state of the organism instead
of being a complete picture. They necessarily feed the autobiographical
memory with partial information and not with a very detailed one.
Anosognosia is a hybrid disorder of consciousness. Patients

develop a defective autobiographical self and their expanded
consciousness becomes anomalous. In addition, and because the
lesions also affect higher-level components of body representation,
patients also have a partially defective protoser.
Asomatognosia
As we have seen, the protoser depends on diverse representations

of the state of the organism in relation to the internal environment,
the organs, vestibular stimulation, and the musculoskeletal framework.
I am tempted to think that not all of these representations are of equal
value for the formation of the proto-being, and I suspect that the
representations of the internal environment and of the organs are of
primary importance. LB, a patient I studied a few years ago in
collaboration with my colleague Steven Anderson, reinforces this
idea. The patient had a condition called asomatognosia, which
literally means "lack of recognition of the body." Patient LB had
suffered a small attack that affected a certain part of the cortex
right-sided somatosensors. Specifically, the second sensory area,

S2 , was damaged . It wasn't enough to cause a permanent sensory
or motor defect or, for that matter, to cause any emotional abnormality.
But as can be the case with some relatively small vascular injuries,
the patient began having seizures originating from the scar tissue of
her injury. In some of the crises there was a remarkable effect: the
patient reported that she was unable to feel her body, by which she
meant, most certainly, that she was unaware of her muscular mass
in her limbs and trunk. The first time it happened, the sensation
caused him alarm. Her mind was working, she knew she was alive
and thinking but she couldn't feel her body in the usual way. Still, she
could feel her heart pounding and decided to do some "checkups,"
including pinching her skin and muscles on different parts of her body.
At first, he felt nothing, but gradually, and after several minutes, he
regained some of the feeling. After about ten minutes, everything was
back to normal. His specific words to describe the crisis were "weird
feeling", "as if I couldn't feel my body". She was clear about the fact
that even though she was strange, she wasn't confused: she knew
perfectly well who she was and she knew perfectly well where she
was.
After being admitted to the hospital and attempting to evaluate

her EEG abnormalities, we asked her to report immediately if a new
seizure occurred. One occurred, a nurse entered her room while the
crisis was unfolding and we were able to interview her shortly after it
was over. The nurse was able to establish that she was a person and
place oriented person during the course of the crisis.
LB was vehement in stating that he was "alert" and described the

situation with extraordinary precision. "I didn't lose any sense of
being, I just [lost] my body."
I interpreted the seizures as the result of temporary deactivation

of a substantial part of the somatosensory cortical complex on the
right side caused by a seizure. The focus of the seizure was probably
located at the margins of her S2 lesion and the seizure extended to
the S1 region located immediately above in the prostolandic gyrus.
The highest level of conjugation of the current state of the organism
was temporarily put on hold. Yet the patient continued to have signals
from her body available in her brainstem, hypothalamus, in isolated
remnants of her right insula, and in left-sided somatosensory cortices.
Those signals could be transmitted to the cingulate cortex. It was
above all the signals belonging to the musculoskeletal aspect of the
body that did not receive an adequate representation in a conjugated
way, while those of the internal environment and organs and
vestibular signaling remained. I assume that vestibular, internal
environment, and organ signaling continued to provide the foundation
for his "sense of being," to use his own words. They provided him
with the part of the protoser in which the central consciousness was
still being generated.
It is important to realize that due to the dominant effect of the

somatosensory cortices (they integrate bodily information for the
whole body and thus for both the right and left sides) the defect
corresponds to both sides of the body even if the lesion is
asymmetrically located on both sides of the body. the right hemisphere.
Patients with anosognosia, which we discussed earlier, have

much more extensive damage to the right somatosensory cortices,
as well as the underlying connections between them and the
connections between them and the cingulate cortex, thalamus, and
frontal region. Like patient LB, they have central consciousness and
are aware of their "self." But the continuously faulty conjugation of
current signals from the organism leads
to a permanent impairment in the updating of autobiographical

memory and inevitably interrupts the smooth flow of their conscious
minds.
Extended consciousness is also compromised in those patients

who develop severe working memory defects, the most dramatic of
which occur after extensive central lobe damage in the outer areas
of both cerebral hemispheres. The range of images that these
patients can keep in mind is quite restricted. As a consequence, the
higher realms of expanded consciousness can no longer be achieved.
We can also find examples of increased consciousness in certain

psychiatric conditions, although, given the complexity of these
conditions, any interpretation within this framework can only be
considered provisional. However, it is reasonable to say that in
various states and in their acute states, mania and depression show
disturbances of expanded consciousness. Arguably, the
autobiographical self in manic states is greatly amplified, while the
autobiographical self is diminished in severe depressions. For
example, some manifestations of schizophrenia, such as thought
insertions and auditory hallucinations, can be interpreted in part as
disorders of expanded consciousness.
In all likelihood, patients thus affected have abnormal autobiographical

memories and display abnormal autobiographical selves. However,
it should be kept in mind that during the onset of such manifestations
the "objects" of his perception may themselves be anomalous, and
that his proto-self and central consciousness may also be anomalous.
Impaired expanded consciousness possibly contributes to the

dissolution of self that accompanies depersonalized states and states
of mystical disinterest, and the same is true of
controversial disease of multiple personalities.

When I discussed central consciousness, I indicated that we view
the behaviors we observe and the conscious mind behind them on
the analogy of the orchestral score to various parts of assorted groups
of musical instruments. I have already examined the "cognitive" and
"behavioral" scores of people with intact or impaired central
consciousness; let's do the same now with expanded consciousness.
Anyone observing a patient with impaired expanded consciousness

would perceive a "behavioral score" quite different from that produced
by a patient with impaired central consciousness. Alertness, low-
intensity attention, and background emotions remain intact, as do
routine behaviors and certain specific emotions. Simple goal behaviors
may even occur. The problem only appears in highly specific behaviors
that depend on substantial knowledge of the past and future. Those
behaviors are clearly impossible and neither are the emotions that are
related to them.
The "cognitive score" of patients with impaired extended

consciousness is a good replica of external observation.
The sense of wakefulness is still present, as is the sense of making
images and paying attention to them, as well as the sense of being
alive and being able to feel. But the higher realms of meaning are
simply not available to the personal mind. The mental representation
of the autobiographical being is so impoverished that the mind does
not know where that being comes from or where it is pointing. A life is
felt but not thoroughly examined.
THE PASSENGER AND THE PERMANENT

The organization of consciousness that I propose resolves the

seeming paradox identified by William James: that the self of our
stream of consciousness continually changes as we move forward in
time, even though we retain the sense that the self remains the same
as it continues. our existence. The solution comes from the fact that
the apparently changing being and the apparently permanent being,
though closely related, are not one entity but two. The ever-changing
self identified by James is the sense of the core self. It is not so much
that it changes as that it is transitory, ephemeral, that it needs to be
continuously remade and reborn. The sensation of a being that seems
to remain the same is that of the autobiographical being, since it is
based on a reservoir of memories of the fundamental facts in the
individual biography that can be partially activated, thus providing
continuity and an apparent permanence to our lives.
This dual arrangement requires the mechanisms of central

consciousness and memory availability. Central consciousness
provides us with a central self, but we also need conventional memory
to construct an autobiographical self, and we need both central
consciousness and working memory to make the autobiographical
self explicit, that is, to display the content of the autobiographical self
in consciousness. enlarged. Creatures with limited memory do not
face James's paradox. They inhabit a world that is just one step away
from innocence. They probably have the seemingly continuous
experience of moments of conscious individuality, but they are not
burdened or enriched by memories of a personal past, much less by
memories of the anticipated future.
In my proposal, the central consciousness is a central resource

produced by a restricted mental and neural system. The fact that the
central consciousness is central does not mean that it depends on a
single structure. We have already seen that a certain number of
neural structures are necessary for consciousness to occur.
central. But the complexity of the system, the multiplicity of its

components and the coordination required in its operation should not
lead us to overlook the following fact: that when we consider the
anatomical scale of the entire brain, the basic system that underlies
central consciousness ( the combination of protoser-supporting
regions and second-order story-supporting regions) is restricted to a
set of anatomical sites rather than being equally distributed throughout
the brain. There are lots of places in the brain that have nothing to do
with making central consciousness.
The robustness of central consciousness stems from its

anatomical and functional centrality and from the fact that any content
of the mind, whether actively processed in living interaction, or
retrieved from memory, can put the central consciousness system
into action, provoke it by so to speak, and in doing so generate a
pulse of transient central consciousness. Central consciousness is
not organized by sensory modalities, for example as such "visual" or
"auditory" central consciousness. Rather the central consciousness
can be used by any sensory modality and by the motor system to
generate knowledge about any object or movement.
The content of the autobiographical self (organized, reactivated

memories of pivotal events in an individual's biography) are the main
beneficiaries of central consciousness.
Whenever an object X elicits a pulse of central consciousness and
the central self relative to object X arises, selected sets of events
from the autobiographical self are also subsequently activated that
elicit pulses of central consciousness of their own.
At any time in our sentient lives, therefore, we generate pulses

of central consciousness for a single or a few targets, as well as an
accompanying set of reactivated autobiographical memories.
Without such autobiographical memories we would have no sense of
past or future, there would be no sense in our
people historical continuity. But without the narration of the central

consciousness and without the transitory central being that is born
within it, we would have no knowledge of the moment, neither of the
memorized past nor of the foreseen future that we have also
committed to memory. Core awareness is a grounding need. It is the
one that precedes, evolutionarily and individually, the expanded
consciousness that we have today. And yet, without expanded
consciousness, the core consciousness would not have the resonance
of the past and the future. The intertwining of core consciousness
and expanded consciousness, of core self and autobiographical self,
is complete.
THE NEUROANATOMICAL BASIS OF THE AUTOBIOGRAPHICAL BEING
To examine the neuroanatomical basis of the autobiographical

self, I will appeal to the theoretical framework in which I have
considered the relationship between mental images and the brain.
That framework postulates a space of images, a space in which
images of all sensory classes are explicitly given and which comprises
the manifest mental contents made known to us by the central
consciousness, and a space of availability, a space in which
memories available contain records of implicit knowledge on the basis
of what images can be reconstructed by recall, what movements can
be made, and what image processing can be facilitated. The
availabilities can retain the memory of an image perceived on a
certain previous occasion and can help to reconstruct a similar image
from that memory; availabilities can also help in the processing of an
image that is being perceived: for example, in relation to the degree
of attention paid to the image and the degree of its subsequent
enhancement.
There is a neural replica of the image space and a neural replica

of the availability space. Structures such as the early sensory
cortices of various modalities support the neural patterns that are
likely to underlie mental images. On the other hand, the higher-order
cortices and the various subcortical nuclei maintain availabilities with
which to generate both images and actions instead of storing or
displaying the explicit patterns manifest in the images or actions
themselves. (See Appendix Figure A.5 for the location of older
sensory cortices and higher-order cortices.) My proposal is that
availabilities are stored in sets of neurons known as convergence
zones.10 A cognitive partition between space of image and image
of availability, therefore corresponds to a division in the brain: 1) in
maps of neural patterns, activated by the old sensory cortices, the
so-called limbic cortices and some subcortical nuclei; and 2) in
convergence zones, located in the higher order cortices and in
certain subcortical nuclei.
(See appendix, section 3, for a more detailed examination of this

matter.)
The brain forms memories in a very distributed way.

Take for example the memory of a hammer. There is no single place
in the brain where we find the entry for the word hammer followed
by a nice dictionary definition of what a hammer is.11 Instead, and
as current evidence seems to indicate, there is in our brains a a
number of registers that correspond to different aspects of our
previous relationships with hammers: its shape, its characteristic
movement when we use it, the placement and movement of the hand
necessary to manipulate it, the result of its action, the word that
designates it in as many languages as we know. These registers are
latent, available and implicit and are located in places
neural cells separated from each other in the different superior

cortices. The separation is imposed by the design of the brain and by
the physical nature of our environment. Visually noticing the shape of
a hammer is different from appreciating its shape by touch; Nor can
the pattern we use to move the hammer be stored in the same cortex
that stores the pattern of its movement as we see it; nor can the
phonemes with which we form the word hammer be stored in the
same place. The spatial separation of the records does not pose any
problem, as can be seen, since when all the records are made explicit
in images, they are only displayed in a few places and are
chronologically coordinated in such a way that all the recorded
components seem integrated without any segregation. .
If I give you the word hammer and ask you to tell me what
"hammer" means, you will provide me with an adequate definition of
that object, without any difficulty and on the fly. One basis for definition
is the rapid unfolding of a number of explicit mental patterns relating
to these various aspects.
Although the memory of various aspects of our relationship with the
hammers are stored in different parts of the brain and in a latent form,
these different parts are coordinated in their circuits in such a way
that the latent and implicit registers can become explicit even in
schematic images, quickly and in close temporal proximity. The
availability of all these images allows us, in turn, to create a verbal
description of that entity that serves as the basis for the definition.
I would like to point out that the memories of the entities and
events that make up our current autobiography probably use the
same kind of framework as do the memories we form of any entity or
event. What distinguishes these memories is that they refer to
invariant and consolidated facts of our personal history.
My idea is that we store records of our personal history in that

same scattered way, in as many higher cortices as is necessary to
accommodate the diversity of our life relationships. These registers
are closely coordinated by neural connections in such a way that the
content of the registers, as such sets, can be retrieved and made
explicit quickly and efficiently.
The key elements of our autobiography that must be reliably

activated almost permanently are those that correspond to our
identity, to our recent experiences and to the experiences we foresee,
especially those in the immediate future. My idea is that these
essential elements arise from the continuously reactivated network
that is located in the convergence zones, located in the superior
temporal and frontal cortices, as well as in subcortical nuclei, such as
those of the amygdala. The coordinated activation of this ubiquitous
network is guided by the thalamic nuclei, while keeping the
components reiterated for long periods of time requires the support
of the prefrontal cortices that are involved in working memory. In
short, the autobiographical self is a process of coordinated activation
and display of personal memories, situated in a ubiquitous network.
Images that explicitly represent such memories are displayed in many
early cortices. Finally, they are maintained over time thanks to working
memory. They are treated like any other objects and become known
to the simple central being by generating their own pulses of central
consciousness.
Sustained display of the autobiographical self is the key to

expanded consciousness. Extended consciousness occurs when
working memory simultaneously holds both the concrete object and
the autobiographical being: in other words, when both the concrete
object and the objects of the personal autobiography simultaneously
generate core consciousness.
BEING AUTOBIOGRAPHICAL, IDENTITY AND SENSE OF THE OWN PERSON
I have already indicated that identity and sense of self, the two
notions that first come to mind when we think of the word being,
require autobiographical memory and demand that it be embodied in
the autobiographical being. The reservoir of autobiographical memory
records houses memories that constitute identity along with memories
that help define our sense of personhood. What we generally describe
as "personality" depends on multiple inputs. An important contribution
comes from the "traits", the set of which we usually refer to as
"temperament" and which are already detectable at birth. Some of
these traits are genetically transmitted and others are shaped by early
developmental factors. Another important contribution comes from
the unique relationships established by the living organism that grows,
with its environment, in physical, human and cultural terms. This last
contribution (which is made in the continuous shadow of the previous
one) is recorded in the autobiographical memory and gives rise to
being autobiographical and to the sense of being a person. In an
enormous variety of situations, from the simplest to the most complex,
from the most beneficial to the most detrimental, the existence of
autobiographical memory allows organisms to consistently evoke both
emotional and intellectual responses.
When we speak of shaping a person through education and

culture, we refer to the combined contributions: 1) of genetically
transmitted "traits" and "dispositions"; 2) from "dispositions" acquired
in the early stages of development under the dual influence of genes
and environment; and 3) of the unique personal episodes lived in the
shadow of the other two contributions, continuously sedimented and
reclassified in autobiographical memory. We can imagine the neural
replication of this complicated process as creating available records
on the basis that the brain can
evoke, assuming the corresponding stimulus, a collection of practically

simultaneous responses that range from emotions to intellectual
facts. Using the convergence zone framework, we can imagine that
these responses are controlled by registers located in specific brain
sites that direct the display of responses in a variety of structures: the
ancient sensory cortices to represent sensory images of various
kinds; the motor and limbic cortices and the subcortical nuclei for the
execution of a wide range of actions, including those that constitute
emotions.
Not only are there many convergence zones and many places of
availability, but they are not even contiguous to each other. In all
probability, some are located in the cortex, while others are found in
subcortical nuclei. Those of the cortex are distributed in the temporal
regions as well as in the frontal ones. In those personalities that seem
to us to be the most harmonious and mature from the point of view of
their habitual responses, I believe I see that multiple loci of control
are interconnected in such a way that responses with very different
degrees of complexity can be organized, some mobilizing as only a
few brain locations, while others require large-scale concerted
functioning, though often involving cortical and subcortical locations.
The simple notion of identity derives precisely from this provision.

In a number of places in the temporal and frontal regions, the
convergence zones support availabilities that can activate in the old
sensory cortices, in a coherent and reiterated way, the fundamental
data that define our personal and social identity: from the fabric of our
family to the network of our friends, going through the list of places
that have marked our lives and the name given to us. Our identity is
displayed in the sensory cortices, so to speak. At any time in our
waking, conscious lives, a coherent set of identity registers is made
explicit to us, such that
so that it forms a backdrop for our minds that can quickly come to the
fore if the need arises. Under certain circumstances, the range of
activated records can be expanded to encompass a larger scope of
our personal history and anticipated future. But moment after moment,
whether or not we extend the range of such memories, they are active
and available. We know that their inactivation does not go unnoticed:
the result of their inactivation is some form of transient global amnesia.
When I first thought of this explanation for the process behind

our sense of identity, I wondered about the burden of constant
repetition and continual internal staging of the same sensory patterns
in order to display the same sensory patterns. information. Wouldn't
that be an intolerable load on the neurons? But I felt reassured when
I thought of other examples of apparently disordered charges in
biological tissue. Think of the muscle cells of the heart, condemned
for life to repeated contraction.
The idea that each of us forms of ourselves, the image that we

gradually build up for ourselves of who we are physically and mentally,
of where we fit in socially, is based on autobiographical memory over
years of experience and is constantly subject to remodeling. (See the
next section on the unconscious). These conscious and unconscious
processes, in whatever proportion, are influenced by all kinds of
factors: innate and acquired personality traits, intelligence, knowledge,
social and cultural environment. The autobiographical being that we
show in our mind, at this moment, is the final product not only of our
innate tendencies and our life experiences, but also of the
recomposition of the memories of those experiences under the
influence of those factors.
The changes that occur in the autobiographical self during a

lifetime are due not only to the remodeling of the lived past that
occurs consciously and unconsciously, but also to the establishment
and remodeling of the anticipated future. I believe that a key aspect
of the evolution of being has to do with the balance of the two
influences: the lived past and the anticipated future. Personal maturity
means that the memories of the future that we foresee for the time
that may lie ahead weigh heavily on the autobiographical self at all
times. The memories of the scenarios that we conceive as longings,
desires, objectives and obligations exert a force on the being at all
times. Without a doubt, they also take part in the remodeling of the
lived past, consciously and unconsciously, and in the creation of the
person we think we are, moment by moment.
Our attitudes and choices are, in no small part, a consequence

of the "opportunity to feel one's own person" that organisms concoct
in the passing of each instant. So it is not surprising that we can vary
and change, succumb to vanity and betray, be malleable and fickle.
Within us is the potential to create our own Hamlet, Iago and Falstaff.
Under the right circumstances, aspects of those characters can
emerge, briefly and transiently, it is to be hoped. In some respects it
is almost amazing that most of us have only one character, though
there are good reasons for the uniqueness. The trend towards unified
control prevails throughout the history of our development, surely
because a single organism requires that there be only one being if
the goal of sustaining life is to be achieved: more than one being per
organism is not a good recipe for survival. . The rich imaginations of
our mind do prepare "multiple sketches" of the script of the life of our
organism... to place the idea in the frame of reference proposed by
Daniel Dennett.12 However, the shadows of the central being,
profoundly biological, and of the autobiographical being that grows
under its influence, constantly favor the selection of «sketches» that
they go according to a unified and unique being. Furthermore,

the delicately shaped selective machinery of our imagination
limits the probabilities of selection to the same historically
continuous being. We can be Hamlet for a week or Falstaff for a
night, but we tend to go back to the original refuge. If we have the
genius of Shakespeare, we can use these inner battles of being
to create the entire cast of characters of Western theater or, as in
the case of Fernando Pessoa, create four different poets with the
same pen. But ultimately, it is Ser Shakespeare himself who
quietly retires to Stratford or Ser Pessoa himself who drinks
himself to death in a Lisbon hospital. In short, that there are limits
to being continuous, single, and unified, as Whitehead points out
in his comments on self-awareness in his Process and Reality;13
human failings and the strange disease of multiple personalities
attest to the existence of such limits and yet the tendency to a
single being and the advantage it entails for a healthy mind are
undeniable.14
THE AUTOBIOGRAPHICAL BEING AND THE UNCONSCIOUS
Florestan, the romantic hero of Beethoven's opera Fidelio ,

finds himself unjustly imprisoned in a dark dungeon. "God, how
dark is this!" he exclaims, and by that he could well be referring
to the darkness in the depths of human memory . of different
sensory classes, of different subjects and of different emotional
importance. We generally have little direct control over the
"strength" of our memories or how easily or difficultly we can
retrieve them. Of course we have all sorts of interesting insights
about emotional value, robustness, and
depth of memories, but not direct knowledge of the mechanics of

memory. We have a strong body of research on the factors that
govern memory retention and retrieval, as well as the neural systems
required to sustain and retrieve memories.16 But what is called
conscious knowledge, we don't have.
The memories that make up our autobiographical records are

found in precisely those same circumstances, perhaps even more so
since the high emotional charge of so many of these memories can
cause the brain to treat them differently. We experience the content
that is in the autobiographical records (we are aware of that content),
but we do not know how they get stored, how much of each, how
firmly, whether superficially or deeply. Nor do we know how the
contents are interrelated as such memories, nor how they are
classified and reorganized in the memory well, nor how the links
between memories are established, nor how they are maintained
over time in the latent, implicit and available mode. in which we have
the knowledge within us. And yet, just as we don't experience any of
these things directly, we do know something about the circuitry that
houses these memories. They are located in abundance in the higher
order cortices, especially in the temporal and frontal regions, and
maintain close network relationships with the cortical and subcortical
limbic regions and with the thalamus.
Neurobiologically speaking, Florestan's dark dungeon will receive

some light before too long.
Indeed, some sets of autobiographical memories are simply and
consistently reactivated moment by moment, and those memories
send into our expanded consciousness the facts of our physical,
mental, and demographic identity, the facts of our immediate
provenance (where we were just before, a few minutes or a few
hours, yesterday) and the facts of our intended immediate future
(what we must do in the
next few minutes or in the following hours, what we have planned for
tonight and for tomorrow). The alteration of this fundamental aspect
of the autobiographical being gives rise to the tremendous neurological
problem that we have found in transient global amnesia.
However, certain contents of autobiographical memory remain
submerged for long periods of time and may never come to light.
Since memories are not archived in facsimile form and must go
through a process of reconstruction during retrieval, it is easy to
imagine that memories of certain autobiographical events cannot be
fully reconstructed, or that they are reconstructed in ways that differ
from the original or that never see the light of consciousness again.
Instead, they may promote the retrieval of other memories that
become conscious in the form of other specific events or as specific
emotional states. In the expanded consciousness of that moment, the
facts thus retrieved may be inexplicable due to their apparent lack of
connection with the content of the consciousness that dominates the
central scene of that moment. The facts may seem unmotivated,
although sub rosa there is indeed a network of connections that
reflect either the reality of a certain moment previously lived or the
remodeling of that moment through a gradual and unconscious
organization of secret memory stores.
Let us now consider the multiple and legitimate meanings of the

word connections in the previous sentence. The word refers to the
connection of things and events as they may have occurred
historically; it refers to the iconic mental representation of such things
and events as we have experienced them; and it also refers to the
neural connection between brain circuits necessary for us to keep
track of those things and events and to re-display such records as
explicit neural patterns. The world of the psychoanalytic unconscious
has its roots in the neural systems that sustain autobiographical
memory, and psychoanalysis
It is often seen as a means of peering into all that tangle of

psychological connections within autobiographical memory.
Inevitably, however, that world is also related to the other types of
connections I have just outlined.
The unconscious, in the restricted sense in which the word has

been recorded in our culture, is only part of the enormous number of
processes and contents that do not become conscious, that are not
known by the central or expanded consciousness.
In fact, the list of "unknowns" is staggering. Let's think about what it
covers:
1. all fully formed images that we do not pay attention to; 2. all the
neural patterns that never become
images;
3. all the availabilities that have been acquired through experience,
that are latent and may never become an explicit neural pattern;
4. all the silent remodeling of such availabilities and all their silent
re-networking, which may never be explicitly known;
5. all the hidden wisdom and practical knowledge that nature has
embodied in the innate and homeostatic availability.
Amazing, indeed, how little we got to know.
THE BEING OF NATURE AND THE BEING OF CULTURE
It is often foolhardy to return to the "nature versus culture"

discussion to try to decide whether a given cognitive function is shaped
in a certain way and in a given individual by the genome, through its
related biological imperatives,
or by the environment, through the influence of culture.

Curiously, when we see consciousness from the point of view that I
propose, distinctions of this type appear more possible. For example,
I would go so far as to say that virtually all of the machinery behind
central consciousness and the generation of the central self is
fundamentally under the control of genes. Except in situations where
the disease disrupts brain structure early, the genome puts the
appropriate neural and humoral brain-brain links in place, lays out the
necessary circuitry, and, with the help of the environment, allows the
machinery to work reliably during the brain. a lifetime.
The development of the autobiographical self is another matter.

Certainly the connection between the central being and the structures
that support the development of autobiographical memory is organized
under genomic control. The same as the processes that are at the
base of what can be memorized and what modeling of cortical and
subcortical circuits can be done, in such a way that the convergence
zones and their availabilities appear. In other words, autobiographical
memory develops and matures under the watchful shadow of inherited
biology. However, unlike the central being, in the development and
maturation of autobiographical memory there must be many things
that are not only dependent on the environment but also regulated by
it. For example, the reward and punishment schemes offered to
infants, children, and adolescents vary across diverse home, school,
and social settings; the shaping of the events that constitute the
individual's historical past as well as his anticipated future is regulated
to no small extent by the environment; the rules and principles that
govern the cultures in which the autobiographical being develops are
under the control of the environment; the same
it occurs with the knowledge according to which individuals organize

their autobiography, and that range from models of individual behavior
to cultural facts.
When we speak of being to refer to the unique dignity of the
human being, when we speak of being to refer to the places and
people that have shaped our lives and what we describe as what
belongs to us and how it lives in us, we naturally speak of be
autobiographical. Being autobiographical is the brain state for which
the cultural history of humanity counts most.
BEYOND EXPANDED CONSCIOUSNESS
Expanded consciousness enables human organisms to reach

the very peak of their mental capacities.
Let's look at some of these: the ability to create useful artifacts, the
ability to take into account the minds of others, the ability to appreciate
the mind of a collectivity, the ability to suffer with pain instead of
simply noticing pain and reacting against it , the ability to feel the
possibility of death in the being and in the other, the ability to value
life, the ability to build a sense of good and bad different from that of
pleasure and pain, the ability to take into account takes into account
the interests of others and the community, the ability to feel beauty
as opposed to simply feeling pleasure, the ability to notice a
discordance of feelings and later a discordance of abstract ideas,
which is the source of the sense of the truth. Among this remarkable
collection of skills that enhanced consciousness allows, two in
particular deserve to be highlighted: first, the ability to overcome the
dictates of advantage or disadvantage imposed by provisions related
to survival and, second, the fundamental detection of mismatches
that leads to the search for truth and the desire to build standards
and ideals of behavior and
analysis of the facts. These two capacities are not only my favorite
candidates for the pinnacle of distinctively human, but they are also
what enable the authentic human function that is so well captured in
the word consciousness. I do not place consciousness, neither in its
central form nor in its enlarged form, at the pinnacle of human
qualities. Awareness is necessary but not sufficient to reach the
current pinnacle.
The chain of precedents is very curious: the non-conscious neural
signaling of an individual organism generates the protoser, which
allows the existence of a central being and a central consciousness,
which in turn ground the autobiographical being, which produces
the expanded consciousness. At the end of the chain, expanded
awareness gives rise to consciousness.
The status of our understanding related to consciousness,
extended consciousness, and central consciousness may well parallel
the order in which human beings seem to have become aware of,
and interested in, such phenomena. Humans identified consciousness
and took an interest in it long before they identified extended
consciousness as a problem, much longer than central consciousness.
The gods of antiquity did not speak to the heroes of the Homeric
poems about matters of conscience but rather about matters of
conscience: think of Athena when she stops the arm of Achilles, as a
boy, and prevents him from killing Agamemnon, in the Iliad . Ten
centuries before our era, the Homeric accounts assume the existence
of central consciousness but do not deal with it explicitly. They
indirectly describe a piecemeal consciousness, dominated by the
gods, but what they are really concerned with is consciousness.17
Solon, seven centuries before our era, is probably already on the road
to consciousness and consciousness: he advises the reader to « to
know oneself.”18 More or less as wise are the Greeks from the year
500 BC. C. onwards, the same as the authors and protagonists of the
Genesis, the authors of the Mahabharata and the shi who compiled
the
Tao te King. But none of them dealt with the notions of conscience
that concern us today. It is not only that the word for consciousness
is not found in Plato and Aristotle, but that nous and psyche are not
their equivalents. The concept does not appear either. (Psyche was
referring to certain aspects of an organism that I believe are
fundamental to the emergence of what we now call consciousness
[breath, blood] or are closely related [mind, soul], but he did not
correspond to the same concept. )19 Concern with what we now call
consciousness is recent (perhaps three and a half centuries) and has
only come to the fore in the twentieth century.
The coinage of the words with which we indicate the "phenomena

of consciousness" in the languages brought to us by Western thought
also seem to indicate that curiosity about and understanding of these
phenomena must have been in the reverse order of their complexity.
In the history of the English language, for example, the Old English
word related to consciousness is inwit, a superb construction that
fuses the notion of interior (in, in) with that of mind (wit). The word
consciousness (from the Latin con and scientia, indicating the
collection of knowledge) has been in use since the 13th century, while
the words consciousness and conscious only appear from the first
half of the 17th century, long after Shakespeare's death (the first
documented use of the word consciousness dates from 1632).
Around 1600, Shakespeare had Hamlet say, "And so conscience
makes us cowards," and what he really meant was conscience, not
conscience.
Although the bard deeply understood the nature of expanded

consciousness and practically planted it in literary form in Western
culture, he never knew how to name it as such. He may even have
realized that there was something like central consciousness lurking
behind expanded consciousness, but central consciousness was not
the center of his concerns.
In English and in his "mother tongue" German, there are different

words for conscience and conscience. In German, the word for
"consciousness" is Bewusstsein and the word for "consciousness"
is Gewissen. In the Romance languages, by contrast, a single word
denotes conscience and consciousness. When I translate the word
"unconscious" into French (inconscient) or Portuguese (inconscient)
I can refer either to a comatose person or to a person whose behavior
is insane. English offers us both unconscious and unconscionable ,
and German gives us unbewusst and gewissenlos. But in Romance
languages only the context can reveal the intended meaning of the
sentence.* Certainly in this matter things can get quite confusing but
always with a point of interest. In Romance languages like French
and Portuguese we can also refer to consciousness with a word that
denotes knowledge, for example connaissance in French and
conhecimento in Portuguese.
Note once more that the alternative words refer to "known facts,"
presumably to the facts that there is a being and that it is to that being
that knowledge is attributed. Whatever word we use to indicate
consciousness, we are never far from the notion of comprehensive
knowledge as betrayed by the use of variants of the prefix con (which
includes) and the word scientia (facts, scientific or not).
When the concept behind the word conscience began to

emerge, the speakers of Romance languages picked up the word
conscience to denote it instead of coining a new word.
The cultural tolerance of the combination of meanings is very curious,
surely one more testimony of the evolution of human concerns in this
matter and deserves its own investigation. We do not know how the
relationship between the concepts of consciousness and
consciousness was given more value than their distinction.
Interestingly, and unlike English and German, the Romance languages
do not have a word to designate being either (reflexive pronouns are
not good substitutes). The
Personal pronouns I or me are considered satisfactory for designating

an entity that could have its own name (a direct translation of self)
but does not.
One might have conjectured that because consciousness is at
the top of the complexity I have just outlined, it would be the last
phenomenon to be considered and understood in terms of its nature
and mechanisms. The truth seems to be the opposite. I would argue
that we know more about the workings of consciousness than we do
about extended consciousness, just as we know more about extended
consciousness than we do about central consciousness. Jean-Pierre
Changeux's work on the neurobiology of ethics, or Robert Ornstein's
on the relationship between consciousness and society supports my
view of consciousness. Daniel Dennett, Bernard Baars, and James
Newman's attempts to elucidate consciousness as expanded
consciousness support the latter's view.20 As far as I can see, the
fulcrum of the mystery lies behind the central consciousness. It may
well be that consciousness and expanded consciousness are only
half explained because understanding them depends, in part, on
solving the problem of central consciousness.
CHAPTER EIGHT
THE NEUROLOGY OF CONSCIOUSNESS
I regard the proposal outlined in previous chapters as ground

zero for a research program on the neural basis of consciousness.
Only further investigation of these proposals, using various approaches,
will be able to decide the merits of the ideas presented here. In the
meantime, however, we can weigh these ideas against the evidence
already available in neuroscience, and that is the purpose of this
chapter.
In Chapters 5, 6, and 7, I have advanced some hypotheses
regarding the mechanisms of central consciousness and expanded
consciousness, and I have pointed out what anatomical structures
would be necessary to support the protoser and the second-order map
required by these mechanisms.
Based on these hypotheses, the following should be true.
affirmations:
1. Bilateral damage to the somatosensory information maps,

which form the neural basis of the protoser, should disrupt
consciousness. The interruption of consciousness should be maximal
at the line followed by a lesion in the upper brain stem and in the
hypothalamus, where the structures of the protoser are very close to
each other, being less strong at higher levels (the cortex of the insula,
S2 , S1 , the parietal cortices related to them), in chains
which the
are processing
further
apart in space.
2. Bilateral damage to the structures that are supposed to

participate in the construction of the story in second order images
about the organism-object relationship, should partially or totally
interrupt the central consciousness. Examples of such structures are
certain nuclei of the thalamus and the cingulate cortex.
3. Bilateral damage to the temporal cortices, including the

inferotemporal region known as IT and the temporal pole known as
TP, should not damage central consciousness, since in those
circumstances the structures required to represent the protoser, to
process most of the objects to know and to create the story in images
of the organism-object relationship are all intact. However, damage to
the temporal cortices will impair the activation of autobiographical
memory records and thus reduce the scope of extended consciousness.
The same can be said for bilateral damage to some higher-order
cortices within the broad prefrontal regions, which also support the
registers with which the autobiographical self can be activated.
4. Bilateral damage to the hippocampus will not damage central

consciousness. However, since the memorization of new facts will be
impossible, it will stop the growth of autobiographical memory, affect
its maintenance and, consequently, alter the future quality of expanded
consciousness.
5. Bilateral damage to early sensory cortices related to external
sensory information (for example, vision and hearing) should not
impair central consciousness except for the inability to represent
aspects of an object given that depend on that particular cortex. The
situation of the somatosensory cortices is exceptional since they
supply part of the base of the protoser. The damage they may suffer
is stated in statement 1 above.
6. Bilateral damage to the prefrontal cortices, even extensive,

should not alter central consciousness.
In the pages that follow, I will assess the validity of these claims in
light of evidence from neuropathology, neuroanatomy, neurophysiology,
and neuropsychology.
EVALUATION OF CLAIM NUMBER 1: EVIDENCE OF THE ROLE OF THE

STRUCTURES OF THE PROTOSER IN THE CONSCIOUSNESS
Statement number 1 states that bilateral damage to the

somatosensory information maps that form the neural basis of the
protoser should disrupt consciousness. This statement is supported by
a combination of evidence obtained in cases of coma, persistent
vegetative state, locked-in syndrome, and basal forebrain damage.
Because the amount of evidence is so enormous, I will focus on the
material on coma and persistent vegetative state and begin by providing
a brief description of what coma and vegetative state look like.1
they seem to sleep
They seem to sleep, they may seem to sleep, but they do not sleep.
There is a universal description of coma, and its clinical description can
be more or less as follows: without warning, the patient falls, remains on
the ground and apparently breathes with some difficulty; he does not
respond to his wife or to the assistance that took him to the hospital; he
also did not respond to anyone in the emergency room and was still not
responding to doctors four days later. If it weren't for the complex of
tubes and cables and electronic screens that surround him, if it weren't
for the fact that he is in a state-of-the-art unit for the treatment of
cerebrovascular diseases, we as visitors might well believe that he is
more than asleep. But the truth is that he has had a seizure and is in a
coma, a very abnormal state from which no continued stimulation can
bring him out.
You can talk to him, you can whisper in his ear, you can stroke
his face and shake his hand, you can do anything you can to assess
these kinds of situations, but he won't wake up.
And yet his heart continues to beat, his blood continues to circulate
and his lungs continue to function, as do his kidneys and the other
organs and systems that serve for immediate survival, with a slight
help from the intensive care team. The problem is the brain. It has
suffered damage from an attack in a small but critical region. The
observable result is the suspension of wakefulness, of emotion, of
attention, of deliberate behavior. The result that we could infer from
our observation is that consciousness has also been suspended. Not
only is it incapable of producing any proof of having a functioning
conscious mind, it does not even provide indirect signs that it has a
mind.
He is alive but his organism has radically changed.

Every night when we fall asleep and reach the state of deep,
restful sleep that we call state 4, we are in relationship with
consciousness and mind in a state similar to yours. We count on
waking up over and over again, and so we don't feel any anxiety
about letting go of awareness and mind for a few hours. The situation
of the comatose patient is, however, quite different: he cannot be
awakened from the type of sleep in which he has been immersed and
the probability of his regaining consciousness is not high. Coma may
persist and death may eventually follow.
It's also possible that your deep coma may lighten and eventually turn
into a permanent state of unconsciousness known as a persistent
vegetative state.
If the situation evolves into a vegetative state, the patient will
begin to show apparent sleep and wake cycles, succeeding each
other in an apparently normal manner. It is something that we can
affirm from two types of evidence. The first is that the
electroencephalogram (EEG) will change, being able to show
for a certain number of hours each day the characteristic patterns of

sleep or wakefulness. The second is that he can begin to respond to
stimuli by opening his eyes.
Unfortunately, there is no evidence that he is regaining consciousness;
the only thing that indicates that is that he has regained wakefulness.
As we have seen, wakefulness is a necessary element of
consciousness (except in dreams, of course), but it is not at all the
same as consciousness. If the patient remains vegetative, his control
of autonomic functions, such as blood pressure and respiration, may
also return to normal. On the contrary, in very few patients and on
very rare occasions, there may be isolated examples of coordinated
movements of the head and eyes, isolated and stereotyped utterances,
an isolated tear or smile. Essentially, however, during the apparently
waking part of the day, patients in a vegetative state exhibit no
behavior, either spontaneous or in response to stimuli, that reveals
the presence of consciousness. Emotion, attention, and deliberate
behavior are not restored in the vegetative state. The reasonable
assumption, corroborated by the reports of the few individuals who
did eventually regain consciousness, is that consciousness is nowhere
to be found.2 The cause of the patient's tragedy is damage to a tiny
part of the brain stem. The brain stem connects the spinal cord with
the large extensions of the cerebral hemispheres.
It is the trunk structure that joins the part of the central nervous
system that sits inside the spinal canal, along the entire spine (the
spinal cord) with the part of the central nervous system that sits inside
the skull. (the brain, in its normal meaning). The brainstem receives
signals from the body proper and also serves as a conduit for those
signals as they travel to parts of the brain higher up; in the same way,
it serves as a conduit for signals traveling in the opposite direction,
from the brain to the body proper. In addition it has numerous
small nuclei and nerve fibers that serve as a connection to itself. It

has long been known that control of vital functions, such as those of
the heart, lungs, and other organs, depends on the brain stem, as
does control of sleep and wakefulness. Therefore, nature places in
an extremely small area of the brain many of the fundamental
pathways that pass signals of chemical and neural events from the
body proper to the central nervous system and that carry signals from
the central nervous system to the body. Alongside these fundamental
pathways are myriads of tiny centers that control many vital functions.
Neither of these pathways nor any of these control centers is

randomly located. Instead, as is always the case with the brain, they
are organized into coherent anatomical patterns, which can be found
in all humans in the same way, and can be found in many other
species in almost the same position.3 When viewed Coma occurs as
a result of damage below the thalamus, destruction occurs from the
midpons or superior pons upwards to the midbrain and hypothalamus.
In addition, the damage must be located in the posterior part of the
brain stem and not in the anterior part.4 The damage caused by
coma and persistent vegetative state usually spares certain cranial
nerve nuclei and various long descending and ascending sections,
but it always damages diverse families of nuclei of the tegmentum
of the brainstem. Among them are some well-known reticular nuclei,
such as the cuneiform nucleus and the nucleus pontis oralis. I will call
them classical reticular nuclei. But the damage also includes
"nonclassical" nuclei that, depending on the author, may or may not
be grouped under the somewhat controversial designation of "reticular
formation."
These nonclassical nuclei comprise a collection of monoamine nuclei

(locus coeruleus, ventral tegmental area, substantia nigra, raphe
nuclei), acetylcholine nuclei, and large aggregates of acetylcholine.
nuclei known as parabrachial nuclei and periaqueductal gray. Finally,

the colliculi may also be damaged, but whether or not the input and
output of signals are interrupted. Their functions are compromised,
and if they are not, the results of those functions cannot be sent to
either the brainstem or telencephalon. (See figure 8.1. The reticular
formation is indicated as a shaded area.)
Do situations of coma and persistent vegetative state support

statement number 1? I think so, although here it is appropriate to
make some comments. As indicated, the extent of brain injury that
normally causes coma compromises numerous structures, from those
found in the classical reticular nuclei, which are known to control
wakefulness, to the nonclassical nuclei, which fit easily on the notion
of protoser that I have >advanced. It could be argued that the
impairment of consciousness seen in coma is poorly explained by
damage to the classical reticular nuclei. Leaving aside the fact that
the neuropathological and neuroanatomical evidence in these cases
is not yet complete, the argument would be problematic since the
probability that the different but contiguous families of nuclei have
truly independent functions is low. That argument would overlook the
anatomical location and functional proximity of the classical reticular
nuclei and the monoamine and acetylcholine nuclei.
These nuclei are anatomically and functionally intertwined with those

that regulate the current state of the body and those that map body
state, and it is clear that the monoamine and acetylcholine reticular
nuclei are influenced by what occurs in the body-related nuclei. 5 Not
that I am suggesting that the classical reticular nuclei and the
monoamine and acetylcholine nuclei do not do what they are
supposed to do: activate and modulate the thalamus and cerebral
cortex. What I am suggesting is that they do so under certain
circumstances that are given, in large part, by the structures of the
protoser that regulate the body and that represent the state of the body.
body in the brain stem. We need to include the regulatory structures

of the body in our picture of the brainstem relative to consciousness,
and we may also need to expand the anatomical characterization of
the protoser to include the classical reticular nuclei; this is a matter
for future research and we cannot decide now.
Figure 8.1. Major anatomical divisions of the brainstem, seen in sagittal section
through the midline of the brain. The anatomical orientation is seen in the small
box to the right of the main box.
Another reason why the argument would not be valid refers to

the fact that some comatose patients, without any sign of
consciousness, may have a normal electroencephalogram, which
could indicate that the functions of the classic reticular nuclei have
been preserved in some way. (or, more simply, that we should be
cautious about interpreting EEG findings in relation to consciousness,
since it is also true that some conscious patients may have an
abnormal EEG).6 In some cases, coma occurs following combined
damage to the upper midbrain and hypothalamus, or following injury
to the thalamus. In both cases, the situation is compatible too
with statement number 1. Damage to the upper midbrain and hypothalamus impairs a
large part of the structures required to make up the protoser. And not least, the damage
stands in the way of ascending pathways to the cortical locations of the protoser and
second-order maps. The same reasoning applies to examples of damage to the thalamus.
It is important that in cases of brainstem damage where consciousness is not

impaired (for example, in the locked-in syndrome), the region described above is left
intact: almost all of the structures I have just listed are outside the brainstem. of the
damaged area in the confinement syndrome. The very different aspect of the locked-in
syndrome deserves a special comment.
May resemble coma
If coma-causing brainstem lesions can help us evaluate statement 1, so can non-

coma-causing lesions, especially if they are located in close proximity to coma-causing
lesions. The most striking example is when damage to the brainstem, just a few
millimeters from the region I have just described for coma, produces instead a
devastating injury known as a locked-in syndrome. As I noted in the chapter on emotion,
patients with locked-in syndrome lose the ability to move voluntarily but remain conscious.
Let me give an idea of the situation.

As with a coma, the tragedy will usually begin without warning. The patient will fall
to the ground as suddenly as in a coma, without movement or speech, and will remain
without movement or speech after the terrible event, throughout his life. Everyone
around you will think it's a seizure, and initially, over a period of hours, days, or weeks,
you'll be in a coma. But
sooner or later, at some point during the hospital examination, it will

become apparent that the patient, still motionless, is awake. There
will be those who suspect that he is conscious. There will be a few
clues: the eyes, and the feeling to a good observer that the patient
has deliberately blinked. In less than a rooster sings, the patient's
destiny will have changed. Upon careful examination it will be found
that he is still able to perform one type of movement: he can move
his eyes up and down, and he can blink. He can't frown, can't move
his eyes to the side, can't move his lips or stick out his tongue, and
can't move his neck, arms, or legs. The only thing he retains of the
ability to act by will control is moving his eyes vertically and blinking.
Thanks to these very modest residual capacities, it can be asked to
look up and does so immediately, just as it can look down when
asked. He hears us speak clearly and understands the meaning of
our words. Is aware. He's not in a coma.
His illness is known as locked-in syndrome, an apt description for the

almost solitary confinement of the patient's mind.
This simple motor activity that is maintained allows for an

emergency communication code: the patient can be asked to say
"yes" by moving the eyes up and "no" by moving the eyes down. And
blinking can be used to identify a letter of the alphabet from a list that
is recited to him, so that he can compose words and phrases, letter
by letter, and thus communicate complex ideas. These codes allow
patients to answer questions about their past and current status and
allow nurses, doctors and family to have a useful dialogue. Coma is
a tragic situation and the duty of describing its terrible consequences
to a family is painful. But imagine what it is like to treat a shut-in, look
into the eyes of someone who has a conscious mind and whose
expression is limited to the simplest codes. The cruelty of this situation
is almost unparalleled in
all medicine, and neurology offers us a long list of cruel situations to

choose from: the situation of a patient with advanced amyotrophic
lateral sclerosis, known as Lou Gehrig's disease, is not better. The
consolation we can derive from facing the sad reality of locked-in
patients is that this profound lack of motor control reduces their
emotional reactivity and seems to induce a welcome inner calm.
In terms of size, general location, and causative mechanism,

locked-in syndrome is the result of damage similar to that produced
by coma. But since the actual location of the damage is different, the
result is also different and is not followed by loss of consciousness.
Locked-in syndrome occurs only when the damage is localized to the
front of the brainstem rather than to the back (see Figure 8.2). And
since the pathways that carry motor signals throughout the body
proper are located, with one exception, in the front part of the
brainstem, the seizure that causes locked-in syndrome destroys those
pathways, thus rendering any possible movement impossible in
virtually all brainstems. muscle groups of the body. The lucky
exception concerns the pathways that control blinking and vertical
eye movements because they travel separately down the back of the
brain stem. For this reason they are saved from the confinement
syndrome and allow some communication to take place. In short, the
critical area that is damaged in a coma is left intact in the locked-up
brain.7
The contrast between the cases of coma and of closure offers

powerful evidence of the specificity of the structures that we have
been dealing with for the generation of consciousness. But at this
point it is convenient to place these comments in a broader perspective
of what we know about this region of the brain. In the pages that
follow, I suggest that an explanation of coma and persistent vegetative
state solely in terms of damage to the ascending reticular activating
system does not do justice to the functional and anatomical complexity
of this area.
Figure 8.2. Location of brain damage in cases of confinement syndrome (A) and
in cases of coma (B). The anatomical orientation is the same as in Figure 8.1. The
lesion that causes the locked-in syndrome is located in the anterior (front) part of
the brain stem. The lesion causing the coma is located in the posterior (behind)
part of the brain stem.
Reflection on the neural correlates of coma and persistent

vegetative state
We have long known with some certainty that the presence of

consciousness depends on the integrity of the brain stem. The part
of the brain stem whose damage interrupts consciousness and the
part whose damage does not interrupt it have been identified by
different neurologists, most notably Fred Plum and Jerome Posner
in their studies of comatose, vegetative, and locked-in patients.
Thanks mainly to their efforts, these last two clinical situations have
been identified and named.8
The part of the brain stem that has to be damaged for a coma
to occur encompasses the region commonly known as the reticular
formation. We can imagine this general region as the eccentric axis
of that tree trunk we know as the brain stem. It goes from the height
of the medulla oblongata, just
above the spinal cord, to the top of the midbrain, just below the
thalamus.9 However, the part of the reticular formation that
interests us most is the one that goes from the height of the
midpons upwards, since only at Beyond that level, brainstem
lesions cause coma.
Some authors are reluctant to use the term "reticular
formation" or "reticular nuclei" because new data on the structures
that compose them reveal that there is no homogeneity in the
anatomy or in the functionality of the region.10 It is the same
problem. precisely what we are dealing with with these “umbrella
terms”, such as, for example, “limbic system”.
On the other hand, for a transitional period, it is reasonable and
useful to refer to terms like 'limbic' or 'reticular', with some
reservations, to make the connection between old and new
viewpoints. Be that as it may, instead of being an amorphous
collection of interconnected neurons forming an unpatterned
lace, that is, a "reticulum," a reticular meshwork, the reticular
formation turns out to be a collection of identifiable nuclei of
neurons, each of which it has specific functions and a set of
preferred connections. For example, the parabrachial nucleus
has been individualized within the traditional reticular formation.
It is well established that it has a role 1) in pain perception, 2) in
regulation of the heart, lungs, and viscera, and possibly 3) in the
neural pathway that allows organisms to appreciate taste. It is
not that the reticular formation has evaporated; rather what
happens is that we are beginning to know what it is made of,
neurally speaking. Some of the acetylcholine and monoamine
nuclei that I have already mentioned and that have an
indispensable role in attention and memory, also have an
essential role in sleep and are also part of the reticular
formation.11 In summary, that some of reticular nuclei have not
been identified until recently and that some of them, with the
outstanding example of the parabrachialis, are hardly known
outside the circle of specialists dedicated to understanding
its functions. Eyes go saucer-sized at the mention of such nuclei,

which brings me to the heart of this comment: Most of these recent
nuclei in the study that belong to the reticular formation have been
identified in relation to their role in homeostasis which, as we have
already examined above, is the regulation of the state of the internal
environment and of the organs. What has mattered to the research
community is how they contribute to, for example, the regulation of
cardiac function or intervening in reward or pain mediation processes.
Its fundamental function, as far as current descriptions in the relevant
scientific literature are concerned, is the regulation of life, the
management of bodily states. Some of these nuclei have also been
studied in relation to sleep, but the relationship of most of them with
their possible role in consciousness has not been investigated.
Figure 8.3. Location of some of the fundamental nuclei of the brain stem.
The anatomical orientation is the same as in Figures 8.1. and 8.2. The PAG
(periaqueductal gray), the PBN (parabrachial nucleus), and most of the
acetylcholine and monoamine nuclei are located in the upper brain stem,
posteriorly. It is the same general region whose injury causes coma.
What we are dealing with, therefore, is a curious fracture in the

history of studies of this general region. A trend in these studies,
dating back almost half a century and unfortunately almost abandoned,
has conceived this region as a frankly homogeneous unit, relating it
to attention, arousal, sleep and consciousness. Those studies usually
refer to the reticular formation as if it were a unit instead of referring
to specific nuclei (MRF, in English, is the reference acronym: M for
midbrain or midbrain, depending on the authors; and RF for reticular
formation; is not a lucky acronym as the superior pontic reticular
formation is part of the unit but falls outside of this designation).
A second trend in these studies focuses on the role that some

individual nuclei have in homeostatic regulation. It might be believed
at first glance that the two tendencies are as incompatible as the
researchers themselves are separated from each other in their
respective laboratories and specialties. On the contrary, I believe that
trends can be very advantageously reconciled. In fact, the different
points of view send us, without intending it, a powerful message: the
brain nuclei related primarily to the management of vital processes
and that represent the organism are extremely close to the nuclei
related to the process of wakefulness and sleep. sleep, emotion and
attention, and ultimately with consciousness (and even interconnected
with them). It is even likely that some of those same cores participate
in more than one of those functions.
The reticular formation then and now
The traditional view of the reticular formation is synonymous with

the set of remarkable experiments conducted by Magoun, Moruzzi,
and colleagues in the late 1940s and early 1950s. In turn, these
experiments were the flower of a pioneering tradition started by Bremer
and Jasper in the previous decade.12 Virtually all of these experiments
were done on animals, most of them cats, under some degree of
anesthesia.
The typical experimental design involved: 1) producing a lesion (for

example, in the preparation known as encéphale isolé [isolated brain],
the spinal cord was separated from the brain stem by a horizontal
section at the level of the cord; in the cerveau isolé [ isolated brain]
horizontal section was made at the junction of the pons and midbrain);
2) electrically stimulate a specific site (for example, a nerve or a
nucleus); and 3) measure the result of the manipulation based on the
change in the wave patterns of the electroencephalogram. The
experiments were not about seeing the behavior of the animals.
The result of these experiments was that the reticular formation

must constitute an activating system, which was called the ascending
reticular activating system.
The task of the system was to keep the cerebral cortex in a state
of wakefulness and alertness. This state of wakefulness and alertness
was then, as now, synonymous with consciousness. The reticular
formation exerted a powerful influence on practically all the sectors of
the nervous system located above, but mainly on the cerebral cortex.
The influence encompassed the entire domain of the cerebral
hemispheres, and the metaphors used to describe its influence typically
appealed to words like arousal or energizing.
The reticular activating system would awaken the cerebral cortex and
place it in an operative state that would allow perception,
deliberate thought and action: in short, it would make it conscious.

Damage to the reticular formation would put the cerebral cortex to
sleep, turn off the light of perception and thought, so to speak, and
make it impossible to carry out the planned action.
These metaphors are usually pretty tight, although it seems to me
that they don't tell the whole story.
The handful of contemporary scientists who have worked on the
reticular formation and its expansion in the thalamus include
researchers concerned with understanding the neural basis of
consciousness and attention, such as Mircea Steriade and Rodolfo
Llinás, and researchers who deal with the study of sleep, such as
Allan Hobson.13 His studies have supported the main conclusions
of the Magoun and Moruzzi experiments and it can be said with
certainty that the reticular formation is involved, in a general way, in
sleep and in sleep. the vigil In addition, it is clear that some of the
nuclei of the reticular formation are especially involved in the
generation of sleep-wake cycles. This is the case, for example, of
the cholinergic neurons of the pedunculopontine region and of the
nuclei concerned with the distribution of norepinephrine (the locus
coeruleus) and serotonin (the raphe nuclei).14 There are intriguing
details about how these different nuclei are involved in the induction
and termination of the dream state, as well as details about their
activation or their silence during that specific sleep in which dreams
occur: paradoxical sleep or REM sleep, movement sleep quick eye.
For example, norepinephrine and serotonin neurons are silenced but
some acetylcholine neurons are very active and their activity is linked
to the appearance of PGO (ponto geniculo-occipital) waves found in
deep sleep that are similar to brain waves. EEGs seen in the waking
state.15 Recent research has also confirmed an important aspect of
earlier observations. Organisms in deep sleep produce slow, high-
amplitude waves in the
EEG, known as "synchronized EEG", while organisms that are in a

state of wakefulness and attention, or in paradoxical REM sleep,
produce fast and low amplitude waves, known as "desynchronized
EEG". But contemporary researchers have significantly qualified this
finding: EEG desynchronizations actually hide sectors of
synchronization related to small, localized regions of the cerebral
cortex in which activity appears to be highly coordinated. In other
words, and as Steriade and Singer independently point out, the term
“EEG desynchronization” is a misnomer, since during this state it is
possible to discover brain regions in which electrophysiological
activity is highly synchronized.16 The most important discovery Much
confirmed by contemporary researchers is that electrical stimulation
of the reticular formation gives rise to a so-called desynchronized
EEG. In other words, the firing pattern of the reticular formation
results in the waking state or the dream state. This intimate connection
between this region and the production of states necessary for
consciousness (wakefulness and attention) is an inescapable fact.
But neither the anatomical region nor the states of wakefulness and
attention are enough to fully explain consciousness.
It has also been shown that certain nuclei of the thalamus,

namely the intralaminar nuclei, which happen to be the receptors for
signals from the reticular formation, are an indispensable part of the
pathway that produces either the waking state or the sleeping state
in the brain. level of the cerebral cortex. In fact, the stimulation of the
MRF produces in these nuclei the same effect that it causes in the
cerebral cortex.17 Rodolfo Llinás has used this series of discoveries
to launch the hypothesis that consciousness, both in the waking
state and in the of sleep with dreams, is generated by a closed-loop
device that includes the cerebral cortex, the thalamus and the reticular
formation of the brain stem. This device depends
of the existence, within the reticular formation and the thalamus, of

neurons that fire spontaneously. The activity of these neurons is
modulated by sensory neurons that carry signals from the outside
world to the brain, but the neurons do not require signals from the
outside world to fire. The mechanisms behind this operation are
enigmatic. Acetylcholine delivery to the thalamus and cortex changes
the behavior of ion channels in target neurons.18 In summary,
contemporary leaders in reticular formation research have concluded
that, in states conscious, the reticular formation generates a
continuous barrage of signals directed to the thalamus and the
cerebral cortex tending to the establishment of certain geometries of
cortical coherence. In a parallel development, the study of sleep
mechanisms has also shown structures in the reticular formation that
are involved in the control of sleep-wake cycles. Since sleep is a
natural state of unconsciousness, it stands to reason that both
consciousness and sleep arise from physiological processes rooted
more or less in the same territory.
It is a completely coherent set of discoveries and the general

explanation that is woven around it is coherent and valuable. That
explanation constitutes an important advance in neuroscience and I
believe that we cannot explain the neurobiology of consciousness
without appealing to it. But I do not think that it is the most complete
explanation that can be proposed to relate this brain region to the
phenomena of consciousness, nor that the neurobiology of
consciousness can be satisfied with these discoveries.
Being aware goes beyond being awake and attentive: it requires

an internal sense of being in the act of knowing. Thus the question of
how consciousness arises cannot be fully answered by postulating a
mechanism that awakens and energizes the consciousness.
cerebral cortex, even if it is specified that, once awake, the cerebral

cortex exhibits specific patterns of electrophysiological activity, locally
and globally, consistent. Undoubtedly, these guidelines are essential
for the state of consciousness. I regard them as providing the neural
correlates of wakefulness and attention during which images can be
formed and manipulated and motor responses organized. The mere
description of these electrophysiological patterns, however, does not
address the issue of being and knowing that, for me, are at the heart
of consciousness.
Those patterns correspond more to the final part of the process of

consciousness as I see it: the part of the process in which the maps
of the object are enhanced, making the object stand out. It is
conceivable that these electrophysiological patterns may also be
correlates of the processes of being and knowing. That this is so must
be verified as a leading hypothesis to specify what part of the
electrophysiological pattern would be correlated with being and
knowing. On the other hand, it is also possible that the aforementioned
patterns (i.e., those of the "desynchronized" EEG in general within
which, upon closer study, localized sectors of synchronization and
periodic events of non-localized synchronization can be found) are
not present. directly related to being and knowing, but rather to the
object to be known.
My reservations about the traditional explanation lead me to the

fact that I indicated at the beginning of this section: that a second
trend of studies on the reticular formation awaits us. In the traditional
trend, the reticular nuclei are involved in the control of wakefulness
and attention. In the second trend, the reticular nuclei, not necessarily
the same as those that have been studied traditionally but others
close and in close contact with them, are part of the innate machinery
with which
the brain regulates homeostasis and, in order to do so, they are receivers of the signals
that represent the state of the organism moment after moment.
a quiet mystery
The importance of the second trend in these studies becomes apparent when we
consider a mystery that has bothered me for a long time: that the reticular formation is
a long, vertically organized structure that covers the entire brain stem from the top of
the spinal cord up to the level of the thalamus, why is it only damage to a specific
sector of the stem, from the superior bridge upwards, that can cause loss of
consciousness, while damage to the rest of the stem does not alter it at all? ? This fact
is well established and need not be retested, but it has quietly remained in the literature
without much comment or explanation. For obviously why should only part of the
reticular formation be related to the creation or suspension of consciousness, and why
should it always be the same, case after case? And why (in order to project the mystery
onto experimental studies of the reticular formation) should the "ascending reticular
activating system" be associated with precisely that same sector of the reticular
formation? Let me try to outline an answer.
The line between the part of the reticular formation whose damage alters
consciousness and the part whose damage does not alter it is quite clear. It can be
visualized well when a plane is imagined that would section the brainstem with an
orientation perpendicular to its longitudinal axis. The height at which the plane should
be placed would be the height at which the trigeminal nerve, known as the fifth cranial
nerve, enters the brain stem. In their book on coma, Plum and Posner note: "The
caudal extension of the structures
critical for cortical excitation surely does not go much lower than the
height of the trigeminal nerve inlet. (See figure 8.3.)
The dividing plane points to many interesting anatomical facts.

First, a number of nuclei involved in higher-order control of
homeostasis, including control of emotion, are located above that
plane. This is true in the case of the periaqueductal gray nuclei (PAG)
and the parabrachial nuclei (PBN). For example, the parabrachial
nucleus (PBN), which is a receptor for whole-body signals related to
the internal environment and organs, is located just above the dividing
plane, beginning at the midpontic level. The nucleus pontis oralis,
which receives important projections from the cerebral cortex and
distributes them to this region, is also located just above the dividing
plane.19 The same is true for the monoamine nuclei involved in
norepinephrine and dopamine delivery and for the acetylcholine
nuclei. They begin to appear at precisely that height and continue to
rise throughout that region. The serotonin nuclei are also located
above this area (although unlike the nuclei of the other three
transmitters, the serotonin nuclei are also located at lower elevations;
however, the projections of these lower nuclei are more oriented to
the medulla). spinal than telencephalon).
Let us now consider why the connection with the trigeminal

nerves may be significant. The trigeminal fibers carry sensory signals
from the structures of the head: the skin of the face and the scalp, the
muscles of both, the alignment muscles of the mouth and nose, that
is, a complete delegation of the internal environment, of the organs
and musculoskeletal aspects of the head. In short, the trigeminal
nerve provides the brain with a final group of information in relation to
the state of the organism, in the direction from bottom to top, namely,
the state of the internal environment, of the organs and of the
musculoskeletal apparatus of the head.
At the lower levels of the brain stem and from the base of the
spine upwards, segment by segment, we find entry points for all the
other nerves that carry signals from other parts of the body:
extremities, chest, abdomen; everything except the head. It is very
clear that the design of the channeling of signals from the whole body
to the brain involves many entry points from the lower aspects of the
spinal cord to the pons, and that all of these signals can only reach
the brain if all the entry points input are intact.
The anatomical clue refers to the fact that the full range of body
signals that convey the current state of the organism is complete only
after the signals from the head enter the brain stem via the trigeminal
nerve. The cranial nerves located at a higher level, respectively the
fourth and the third, do not contribute to the integral representation of
the body. They do not introduce but rather remove motor and
autonomic commands from the brain stem. The second and first
cranial nerves are connected, respectively, with vision and smell.
They do not enter the central nervous system at the level of the brain
stem and do not provide signals of internal states of the body.
Once trigeminal signals become available to a number of nuclei

located both above and slightly below the entry point (the trigeminal
nucleus is aligned vertically along the stem, above and below the
entry point) , the brain is in possession of the full range of signals that
indicate the state of the body and use a neural pathway, and is even
in possession of some signals that indicate the state of the body and
use a chemical pathway (arriving via the area postrema). ). The only
thing that the brain lacks, in relation to the state of the body, is the
chemical signals that the hypothalamus and the
subfornical organs. Interestingly, at about this point, the brain is also

in possession of auditory, vestibular, and gustatory information, and
that in the region above the dividing plane, visual signals are already
normally available: they arrive directed at the tectum, but their
projections subsequent ones are distributed to the reticular nuclei.
This seems to indicate that one of the strong correlations

discovered so far between brain structure and state of consciousness
has a lot to do with the design of the input of bodily signals into the
central nervous system. Around and above the dividing plane , after
all neural signals and some chemical signals from the body have
entered the central nervous system, there are a number of brainstem
nuclei involved in regulatory homeostasis that already have a "whole"
view of the current state of the body, something that is vital for the
regulatory process. The entry of the trigeminal nerve is just a clue,
an indicator of the beginning of a region above which evolution would
have chosen to place the life-regulating devices whose normal
operation depends on the input they receive from the whole organism.
I suspect that the classical reticular nuclei are also situated above
the trigeminal plane and in close proximity to the life regulation nuclei
because the reticular nuclei respond to circumstances of life regulation.
When injury occurs around or above the trigeminal nerve, the

foundations of the protoser are compromised, as is the representation
of protoser changes on second-order maps. Deprived of the
grounding aspects of the protoser, the organism can no longer
represent the fundamental substratum of knowledge, the current
internal state, as well as the changes it undergoes when the organism
relates to an object, existing or remembered. Under these
circumstances, regardless of concomitant lesions in the nuclei
classical reticular, the entire mechanism of consciousness should

collapse. Naturally, if the classical reticular nuclei are guided by
structures of the protoser, the danger is even greater.
The anatomy of the protoser from the point of view of classical

experiments
The results of classical experiments on the reticular formation are

consistent with the hypothesis I have been examining regarding the
neuroanatomical basis of the protoser. In essence, four different
discoveries must be taken into account. The first is the discovery that
in cats with encéphale isolé, which consists of separating the brain
at the junction of the spinal cord and medulla oblongata, there are no
subsequent changes in EEG patterns. This is certainly a feasible
prediction from my hypothesis and is supported by the fact that
patients with spinal cord or spinal cord damage do not have impaired
consciousness.
The second discovery comes from the preparation known as

cerveau isolé, in which the cat's brain stem is severed at the junction
between the pons and midbrain. The result is a serious disorder : the
animals are not awake, neither in their behavior nor in relation to what
is seen in their EEG. This is also in agreement with the hypothesis
and with the results of natural lesions in humans. Impairment at that
height would preclude any cross-signaling between the vital structures
of the pons just examined and any other structures higher up, namely
the thalamus and cerebral cortex.20 The third finding is especially
interesting. It refers to two types of section practiced in jacks
approximately towards the middle height of the bridge, one of them
immediately above the point of entry of the nerves
trigeminal, the other about four millimeters higher. In the study by

Batini, Moruzzi et al.,21 two different results were obtained for the
two different sections. The section just above the trigeminal level led
to permanent wakefulness, as indicated by EEG, while sections
slightly above led to severe disturbance of wakefulness, both
behaviorally and EEG-related, not unlike the Obtained by making
pontomesoencephalic sections in the preparation of cerveau isolé.
Let me start by addressing the second type of section, the one

that is made about four millimeters above the plane of entry of the
trigeminal nerve. Although not as damaging as the extensive lesions
that cause coma by damaging these nearby areas, this section
probably had at least three consequences: first, it damaged the
acetylcholine nuclei located at the level of the section and interrupted
the transit of they up; the second, which damaged downward sending
from the cortexes, thus making it impossible for cortical signaling to
enter the tegmental region of the superior pons; and the third, which
damaged part of the parabrachial nucleus. Individually or in
combination, these three effects interrupted the normal process of
consciousness, for example by interfering with the feeding of signals
to the structures of the protoser, both from higher and lower structures.
So the results obtained in the cat are in line with the hypothesis.
However, the results of the section made four millimeters below,

at the level of the entrance of the trigeminal nerve, are even more
interesting. Although there is no way of knowing what the result was
in the cats' state of consciousness, their EEG became typical of
permanent wakefulness. The interpretation of this finding is as follows:
first, the section precluded the sleep-producing effects of the tractus
solitarius nucleus, which is located below the level of the section and
is known to exert hypnogenic effects; Second, the section
it did not damage any of the structures that make up the base of
the protoser, thus allowing signals from the cortex and thalamus to
enter that fundamental region and alter the state of the protoser.
Which would be possible since the animal would continue processing
visual stimuli, thus activating the thalamocortical and tectal regions.
The visual accommodation apparatus, as well as the vertical
movements of the eyes, would have been left intact, memories could
have been extracted from cortical structures, and all of these
processes would have safely sent their signals to the intact brainstem
region that would lie ahead. above the cut. Finally, the chemical
information related to the general state of the body would continue
to be connected to the central nervous system via the hypothalamus
and the subfornical organs, and the consequences of their signals
would reach the structures of the protoser located above the plane
of the section. In short, unlike patients with coma-inducing injuries,
and unlike cats with sections performed either slightly higher, or
much higher, at the pontomencephalic junction, cats with this
particular type of section would retain intact all the structures
necessary to supply the protoser, as well as the residual means of
signaling changes that occurred in the organism and sending the
signals to those structures. This situation, combined with the lack of
sleep-inducing influences from below, would explain the waking EEG
and would also explain sustained wakefulness, including sustained
attention. Whether or not consciousness can still be normal is a
question that cannot be decided on the basis of this experiment, and
certainly can never be answered in human beings, since no natural
lesion will ever be so concrete as to produce such a defect.
selective.22
Reconciliation of facts and interpretations

Although they ostensibly address unrelated functions, I suspect

that the results of research trends in the reticular formation are deeply
connected. The two trends of studies have been motivated by different
issues, but in my frame of reference their interconnection is beginning
to be visible. Consider as an example my interpretation of a recent
discovery made in an experiment by Munk, Singer, and colleagues.23
Munk and colleagues were able to produce in cats that
"desynchronized" EEG with characteristics of "local synchronization"
that is indicative of states of wakefulness and attention. They did this
by directing their electrical stimulation at the reticular formation of the
midbrain. However, they indicated in a footnote that what they had
really stimulated was the parabrachial nucleus, which was
revealed in the autopsy of the experimental animals (in the autopsy it
is possible to see the imprint of the stimulation electrodes, and the
placed in and around the parabrachial nucleus). In summary, that the
electrical stimulation of a nucleus of the reticular formation that until
that moment has been associated with the autonomic regulation of
the heart, lungs and viscera, as well as with states of the body such
as pain, produced a cortical electrical state that it is the characteristic
of wakefulness and attention and that was traditionally associated
with the classic reticular nuclei.
Another experiential connection between the two tendencies

comes from my laboratory work in the area of emotions. In a series of
studies of healthy human subjects with neurological diseases (carried
out in collaboration with Antoine Bechara, Thomas Grabowski, Hanna
Damasio and Josef Parvizi) we have been able to induce a whole
range of emotions experimentally and to demonstrate, using CT
positron emission tomography (PET), that brainstem structures in the
superior reticular formation become remarkably active in some
emotions but not in others.
Could this activation be a consequence of the state of attention

in which the subjects need to be in order to experience these
emotions? If so, our finding would be interesting but not new, given
what we already know from traditional studies of the reticular
formation and given that a previous study by Per Roland and
colleagues revealed activation of the reticular formation during a
task. that demanded attention.24 However, attention alone cannot
explain our findings. To begin with, the control task we use requires
a comparable degree of attention to the images.
If the discovery to which we attribute the emotion had been due to

attention, the activation would have vanished during the disappearance
of the control task. In addition, the findings were different for the
different emotions. We found maximum activations in the brainstem
for emotions such as sadness and anger and low activation for an
emotion such as happiness. And yet, the subjects were performing
the same task across all emotions, and there is nothing to suggest
that the demand for internal attention varied with those emotions. It
is likely that the higher reticular activations were linked to the neural
process required for particular emotions and to produce the
subsequent feeling associated with those emotions.
This discovery adds to the evidence suggesting that the

structures of the reticular formation, traditionally linked to the control
of sleep-wake cycles and attention, are also linked to emotions and
sensations, as well as to the representation of environmental states.
internal and visceral and autonomic control. There is abundant
evidence that this is the case, especially with regard to periaqueductal
gray (PAG). The repertoire of bodily changes that define the various
emotions is in fact controlled by the PAG.25 In short, it is plausible
that the structures of the so-called reticular formation of the upper
bridge and midbrain are linked to the notion of protoser that I have
previously advanced. This may well be the fundamental reason why

they can also be associated with apparently distinct but nevertheless
closely related functions, such as emotions, attention, and ultimately
consciousness.
Another enigmatic discovery of my research group comes from
a study carried out in collaboration with Josef Parvizi and Gary W.
Van Hoesen.26 The study involved detailed mapping of the nuclei of
the reticular formation in patients with Alzheimer's disease, as well
as age-matched normal control patients, revealing a surprising new
finding: the majority of patients with advanced Alzheimer's had severe
destruction of the parabrachial nucleus, on both the right and left
sides of the brain stem. The parabrachial nucleus was damaged in
all patients with early-onset Alzheimer's disease, a particularly severe
form of the disease, and in 80% of patients with late-onset Alzheimer's
disease.
Given that patients with advanced Alzheimer's have markedly

impaired consciousness (see Chapter 3), it is reasonable to ask
whether parabrachial damage might be related to the decline in
consciousness. Certainly his decline in consciousness cannot be
explained by the already well-known involvement of the entorhinal
cortex and the proximal temporal cortices . comfortable with
correlations between particular impairments and particular locations
with neural degeneration. For example, the posterior cingulate
cortices and the middle parietal association cortices are also at
serious risk in Alzheimer's and, as previously indicated, are places
with very good possibilities to house second-order maps.28
In conclusion, I see a powerful fact emerging from the fundamental

brainstem region that we have been examining: that it is simultaneously
involved in processes having to do with wakefulness, homeostatic
regulation, emotion and sensation, attention and perception.
awareness. This functional overlap may seem haphazard at first
glance, but when you think about it, and think about it within the
framework proposed in the previous chapters, it seems sensible.
Homeostatic regulation, which encompasses emotion, requires
periods of wakefulness (to absorb energy), periods of sleep
(presumably for the restoration of depleted chemicals necessary for
neuronal activity),29 attention (for a proper relationship with the
environment ) and awareness (so that a high degree of response
planning can occur in relation to the individual organism).
The corporeal relationship of all these functions and the anatomical

intimacy of the nuclei that support them is quite apparent.
This view is consistent with the classical idea that there is a
device in the upper brainstem capable of creating special types of
electrophysiological states in the thalamus and cortex. Indeed, what I
propose accepts this classical idea but differs in the following ways:
first, it provides a rationale for the origin and anatomical location of
the device, and second, it posits that the actions of such a device, as
discussed described, contribute importantly to the state of
consciousness but do not produce that subjective aspect that defines
consciousness.
EVALUATION OF CLAIM NUMBER 2: EVIDENCE OF THE ROLE OF THE

SECOND-ORDER STRUCTURES IN CONSCIOUSNESS
Let us now return to statement number 2, which refers to damage

to the regions presumed to be involved in the second-order neural
pattern underlying central consciousness: the
cingulate gyrus, thalamic nuclei, and superior colliculi. Remind yourself

again, reading these comments, of my reservations about phrenology.
I am not suggesting that any one of these regions in isolation is
responsible for the neural pattern that is essential for consciousness
to arise. In all probability, the fundamental neural pattern is based on
the interactions of different regions.
My first choice for the second-order structure is a large portion of

the cerebral cortex known as the cingulate cortex.
Located near the midline, with a cingulate cortex in each hemisphere,
this cortex is divided into numerous cytoarchitectural regions (see
Appendix Figures A.4 and A.5). In its anterior section, the structure is
dominated by areas 24 and 25, immediately visible around the anterior
part of the corpus callosum. However, two other cytoarchitectural
areas, areas 33 and 32 respectively, despite their remarkable size,
are barely visible because they are embedded in grooves. The
posterior part of the cerebral cortex is constituted by area 23, quite
visible on the long crown of the gyrus, and by areas 31, 29 and 30,
which are also quite extensive but embedded in grooves and therefore
hidden.
The easiest way to summarize the known functions of the

cingulate cortices is to say that they encompass a rare combination of
motor and sensory roles. The cingulum is a largely somatosensory
structure that receives input from all the divisions of the somatosensory
system described in Chapter 5.
These include not only a remarkable number of signals from the
internal environment and organs, but also important signals from the
musculoskeletal division. And yet, the cingulum is also a motor
structure involved directly and indirectly in the execution of an
enormous variety of complex movements, from those that have to do
with vocalization to those that involve the limbs, alone or synergistically,
and those that involve the internal organs. But not
Is that all. The cingulum is also clearly involved in attention processes,

clearly involved in emotion processes, and clearly involved in
consciousness. This overlapping of functions is remarkable and is
reminiscent of another sector of the central nervous system: the
upper brain stem.
It is reasonable to say that we know a lot but not too much about
the girdle. Despite a number of remarkable neuroanatomical studies,
the intrinsic anatomy of the cingulate and many of its connections to
other regions remains uncharted territory.30 This is also true of the
neurophysiology of the cingulate, which remains somewhat of a
mystery above all. regarding the posterior sector. One explanation
for this panorama of ignorance has to do with the paucity of naturally
occurring bilateral cingulate lesions in humans. Injuries are quite rare
in the anterior cingulate and extremely rare in the posterior cingulate
as well. Note that not a single case of bilateral cingulate injury has
been reported involving all of the cytoarchitectural regions I have
listed above.
In these circumstances, proceed with caution. We know that

epileptic seizures that originate in the cingulate cortex are
characterized by loss of consciousness: periods of absence that are
longer than those caused by normal seizures not originating in the
cingulate cortex. Some important insights have also been offered by
a number of studies of neurofunctional iconography. Situations in
which consciousness is diminished or suspended, such as low-wave
sleep, hypnosis, and certain forms of anesthesia, are associated with
reduced activity of the cingulate cortex; on the other hand, REM
sleep, as well as myriad paradigms of attention, are associated with
increased activity of the cingulate cortex.31 In both lesion studies,
as well as functional iconography studies, the cingulum has been
associated to emotion, attention, and autonomic control.32
Bilateral anterior injuries
of the cingulum originate the situation of the so-called akinetic mutism.

As we saw in the case of L (chapter 3), patients with bilateral damage
to the cingulate cortices have altered consciousness, although they
remain awake. The patients' situation is best described as suspended
animation, both internal and external, and that is why the patients are
described as akinetic and mute. From the literature and my own
observations I can confidently say that bilateral anterior damage to
the cingulate fold disrupts both central and extended consciousness
while awake. However, it should be realized that although affected
patients do not regain a completely normal mind, they do regain
central consciousness within months. His recovery could be due to
the preservation of both posterior cingulate regions. Bilateral damage
to the posterior cingulate may result in permanent damage, but I have
only studied one convincing case. Be that as it may, it is reasonable
to speculate that bilateral damage to the entire cingulate girdle is likely
to markedly interrupt consciousness, perhaps even permanently. Of
the two large sectors, anterior and posterior, of the cingulum, I would
also dare to say that the posterior sector is the essential one, although
I imagine that normal operation requires that both sectors work in
coordination.
I should add that patients with a lesion in the region just behind
the posterior cingulate also have disturbances of consciousness. The
region is medial and parietal, a combination of retrosplenic and cuneus
territories. Cytoarchitectural areas 31, 7 and 19 are part of this region.
Patients with bilateral damage to this area have a profound disturbance
of consciousness. Their impairments are not as marked as those seen
in coma but are comparable to those I have described for the case of
bilateral damage to the cingulum.
As in the case of patients with bilateral cingulate damage,

patients with bilateral medial parietal damage are awake in the usual
sense of the expression: they may have open eyes and muscles with
appropriate muscle tone; they can sit or even walk with assistance;
but they do not look deliberately at anyone or any object, and may
stare into space or orient toward objects for no apparent reason.
These patients cannot take care of themselves. They do not provide
any information about their situation and they do not know how to
respond to practically any of the requests of their examiners. Attempts
to draw them into a conversation are rarely successful and erratic at
best. We can get them to briefly look at an object, but the request
will not cause anything else that can be understood as a productive
reaction. These patients react the same to family and friends as they
do to doctors and nurses. The notion of behaving like a zombie could
very well have originated in the descriptions of these patients, even
if it did not.
The most common cause of involvement of the middle parietal

region is Alzheimer's disease. Apart from degenerative diseases,
bilateral parietal damage is not a frequent consequence of an attack.
The case of bilateral parietal damage that I remember most vividly
was caused by two fairly symmetrical metastases of colon cancer: to
represent how the patient was doing, imagine the state of automatism
of absence described in chapter 3 but in slow motion and without
end. Head injuries can also cause this situation. The renowned
neurologist Macdonald Critchley mentioned such a case in his
seminal monograph on the parietal lobes.33 Reflection on the
anatomical features of the cingulate cortex indicates that it is an
excellent candidate for the type of second-order structure I have
proposed above.
Its different subregions and the impressive number of somatosensory

inputs surely give rise to the most
"integrated" state of an organism's body at any given time. But as the

cingulate cortices are also repositories of signals from the main
sensory channels (the appearance of an object can easily reach the
cingulate via thalamic projections, via direct projections from the
higher order cortices of the inferotemporal, temporal polar and lateral
parietal regions). ), the cingulum could contribute to generating a
neural pattern in which the relationship between the appearance of
the object and the modifications suffered by the body could be
mapped in the appropriate causal sequence. The girdle may actually
make a major contribution to the "feeling of knowing," that special
higher-order feeling that defines central consciousness.
The reasons why the superior colliculi also qualify as second-

order pattern structures are as follows. The superior colliculi are
multilayered structures that receive a multiplicity of sensory information
from a variety of modalities, integrate signals in a complicated way
between their various layers, and communicate the resulting
information to a variety of nuclei in the brainstem, thalamus, and
thalamus. and from the cerebral cortex.34 For example, the superior
colliculi receive visual information directly from the retina in its upper
layer and only a few layers below it also receive information from the
visual cortices, they receive auditory information from the inferior
colliculi located just below and abundant information somatosensory
(including information about internal organs) from various brain stem
nuclei.
The integrative activity of the superior colliculi is directed at

orienting the eyes, head and neck, and ears (in creatures that move
them) toward the source of the visual or sound stimulus, so that a
optimal processing of
object. In the course of that activity, the superior colliculi map the
temporal appearance and position in space of the object, as well as
various aspects of the body's state. It seems conceivable that each
of the seven cell layers could be dedicated to mapping a second-
order neural pattern that describes the organism-object relationship
based on the data available to them. The result would influence the
classical reticular nuclei (and subsequent cortical processing, via the
intralaminar nuclei of the thalamus), as well as the monoamine and
acetylcholine nuclei. In species with poor cortical development this
could be the source of the simple form of central awareness that can
accompany the performance of attention-demanding behaviors. I
hasten to add that, in the case of humans, there is no evidence that
the superior colliculi can support central consciousness in the absence
of thalamic and cingulate structures, even assuming that the brainstem
protoser structures were intact.35
Finally, there is the matter of the thalamus. Reviewing the

neuroanatomy and neurophysiology of the thalamus is beyond the
scope of this book. As in the case of the cerebral cortex and the brain
stem, the thalamus is a matter for entire books and not for a few
paragraphs. However, and just to support my argument, I can say
that the thalamus obtains first-hand "reports" of the sequential linkage
of the various structures that represent both the characters and the
events in that supposed primordial plot. The thalamus could implicitly
signal the object-organism relationship and continue to create more
explicit neural cues in the cingulate and somatosensory cortices.
Some thalamic nuclei, such as the reticular nucleus and the pulvinar
nucleus, would be essential in this process. The idea that the thalamus
is related to consciousness is based on credible experimental
evidence obtained
with animals, from thalamic lesions, and on the likelihood that

abnormal discharges in absence seizures, during which consciousness
is interrupted, originate in the thalamus.36 Current evidence on the
thalamus, however, is inconsistent. insufficient to address the
hypothesis with a certain degree of precision, although they are in
agreement with the general prediction. We should be content to draw
the conclusion that bilateral damage to the thalamus safely disrupts
consciousness.
To conclude, I will add a curious and potentially significant piece

of evidence. In the summer of 1998, my colleagues and I had a
collective recognition experience when a guest speaker came to our
department to give a talk not on consciousness but on
neuroiconographic studies in children.
In his talk, the speaker presented a series of images from PET scans
obtained shortly after birth and in the very first months of life. From
the start, the structures that are remarkably active in these newborn
brains, almost like scattered islands in a sea of silent neuroiconography,
are the brainstem and hypothalamus, the somasensory cortices, and
the cingulum. As can be seen, the set of activated structures fully
matches those required for protoser and second-order maps. The
functional maturity of these structures at birth is remarkable. Since
other brain systems are also in full swing, for example the auditory
ones, the activation seems to indicate considerable functional
precedence. The next structures to appear on PET scans, within a
few months, are the midventral frontal lobe and the amygdala. Then
some of us looked at each other with an air of complicity; the speaker
would surely wonder why.37
EVALUATION OF THE OTHER STATEMENTS

Let us now turn to the remaining statements that refer to places

in the brain whose injury should not cause impairment of central
consciousness: the hippocampus, the superior cortices of the frontal
and temporal lobes, and the old sensory cortices of vision and hearing.
In short: Bilateral damage to any of these areas individually

leaves central consciousness untouched. The sense of being and
knowing continue to function efficiently in relation to any object that
can be adequately mapped. This fact underlines the following
situation: that the protoser and the second-order maps depend
fundamentally on a set of paramedian structures: the brainstem, the
hypothalamic, thalamic and basal forebrain nuclei, as well as the
centrally located cingulate cortices; while the mapping of objects
depends fundamentally on sensory cortices that are not so central
and distributed on the cortical layer. The right and left halves of the
"being and knowing" structures are located in the center, facing each
other, and are often damaged together by the same pathological
cause; the right and left halves of the structures on which object
mapping depends are widely separated from each other and are often
damaged independently.
We can say with confidence that bilateral damage to the

hippocampus or the entire anterior temporal lobe or the entire lateral
temporal lobe or most of the middle and inferior temporal lobes does
not cause impairments in central consciousness. HM and David, two
patients we already examined in chapter 4, unequivocally indicate
this fact. The truth is that even a combination of all these injuries does
not interrupt central consciousness. Bilateral damage to the amygdala
also leaves central consciousness intact as Patient S clearly shows
(Chapter 2). Needless to say, unilateral damage to any of these
structures does not cause impairment of central consciousness.
The entourage of damage caused by all these injuries that leave

consciousness intact is legendary. Profound impairments in learning,
memory, and language are well-known results of such injuries. But
despite these notable deteriorations, patients continue to be perfectly
aware of their being and their surroundings, with their central
consciousness untouched. They are perfectly aware and most are
usually aware of their disabilities. They are very conscious possessors
of interrupted memories and impaired language.
Similarly, bilateral or unilateral damage to the auditory or visual

cortices and the prefrontal cortices does not impair central
consciousness at all. Basically, the ability of patients to perceive and
recognize stimuli through the auditory or visual channel and the ability
to create internal images of these sensory modalities are impaired; In
addition, there are selective memory defects related to the sensory
channel that has been threatened. However, the central consciousness
continues its course normally, saving the affected sensory modality.
Bilateral damage to the old visual cortices is usually restricted to

a subsector and results in visual loss in part or all of the visual fields.
It also often creates one of the many amazing situations in which the
visual process is interrupted. For example, the ability to see color in
all or part of the visual field may be lost, while the ability to perceive
motion, depth, and shape remains intact (a condition called
achromatopsia); o the ability to recognize previously familiar objects,
even though appreciation of the physical structure of the object
remains intact; or the ability to scan the visual field harmoniously and
attentively may fade (in what is known as Balint syndrome).38 In all
these examples, central consciousness remains intact, the patient is
able to process any aspect of cognition normally. except for the
selectively interrupted aspects of visual processing. Let the patients
be
acutely aware of what they can no longer do indicates that the

"general" process of central consciousness has been preserved.
Equally interesting is the fact that some of these patients retain certain
aspects of nonconscious processing related to stimuli that they can
no longer perceive or recognize. A clear example of the above occurs
in the condition known as blindsight.39 In some patients who have
completely lost their vision as a result of what has been called cortical
blindness, patients can state, and they are right, that they do not see
a certain object in their visual field and yet be able to point, when
asked to do so, to the possible location of the object, moving their arm
and finger in the correct direction. Which indicates that some correct
processing is taking place, so that the structures in charge of
movement can guide the arm and finger in the proper direction even
if some of the information underlying such processing does not
become available to the process. that makes consciousness.
Something similar can occur in equally blind patients when the

damage to the visual cortices is especially extensive, in the situation
known as Anton's syndrome. Patients may deny being blind, as
described above for anosognosia, but such an outlandish claim may
be partially explained. Patients' eyes are still able to look at objects
that are attractive to a visual organism and are still able to focus on
them. The result of these efforts of the now useless visual-perceptual
machinery is of no importance to the visual cortices themselves, but
nevertheless continues to reach structures such as the superior
colliculi and the parietal cortices. The brain remains informed of a set
of adjustments related to perception, surely not different from those
that would occur if the brain were still capable of visual processing.
In a situation where visual processing is completely absent, the

brain constructs a reasonably adequate explanation for those
perceptual adjustments that are perceived in consciousness: an
explanation that, in fact, says that an object is being seen. Of course
the explanation is not adequate, but neither is it completely irrational.
In the cases I have seen, that belief vanishes in a matter of hours,
which is to be expected. I am persuaded that the complete absence
of existing or remembered visual images during the first hours of the
situation explains why the patient is wrong. The deep flaw in visual
imagery prevents me from building a counterargument.
I have devoted many studies, as well as Descartes' Error, to the

situation of patients with bilateral damage to the medial ventral
prefrontal lobe. I can confidently say that while your ability to make
appropriate decisions and emotionally tune into certain issues is
impaired, your core consciousness is not. Even bilateral damage to
the dorsolateral prefrontal cortices, including the frontal pole, does not
lead to impairments in central consciousness.40 Such damage impairs
working memory and thus affects extended consciousness, but leaves
central consciousness intact.
The "negative" evidence provided above is just as important in

identifying brain territories where consciousness may emerge as the
"positive" evidence referring to territories that lead to unequivocal
impairment of consciousness. From the aforementioned negative
tests I would like to emphasize that bilateral damage to the
hippocampus does not impair central consciousness, any more than
bilateral damage to the visual or auditory cortices impairs it.
The significance of the negative test is as follows: the

hippocampus is a receiver of information from different sensory
modalities and its circuitry is such that its signals can build, in a way,
an n -order map of the
«scene» that at each moment results from the multiple image-making

devices of the organism. Therefore, it could be conceivable that the
hippocampus would be an ideal structure to generate the second-
order map that I have proposed as the basis of central consciousness.
However, this may not be the case, as numerous studies of patients
with bilateral hippocampal damage indicate. Profound defects in
learning and memory can always be found in such cases, but
impairment of central consciousness never results.
CONCLUSIONS
The above evaluation of the available evidence allows us to

draw a number of tentative conclusions.
1. Damage to the brain regions that are supposed to support the
proto-self or the second-order account of the organism-object
relationship, disrupts central consciousness.
Expanded consciousness is also interrupted.
2. The regions that support the protoser or the second-order maps
have special anatomical characteristics: a) they are among the
phylogenetically oldest structures in the brain; b) they are mostly
located near the midline; c) none is located on the external face
of the cerebral cortex; and d) all are involved in some aspect of
bodily regulation or representation.
3. The protoser and the second order structures constitute a central

resource and their dysfunction causes a general interruption of
consciousness in relation to any object. Old sensory structures
are involved in processing aspects other than objects, and thus
damage to one of these structures, even a large one, does not
affect consciousness in general.
4. The regions whose injury does not cause an interruption of

central consciousness, together constitute a greater proportion
of the central nervous system than those that do disrupt
consciousness.
5. Those same regions (ie, the sensory cortices, the higher-order
cortices) are mainly involved: a) in signaling the objects and
events that become known thanks to the central consciousness;
b) in keeping records that correspond to their experience; and c)
in manipulating those registers turning them into reasoning and
creative thinking.
6. Ancient sensory structures are also involved in the process of

making consciousness. They do it differently: there is only one
set of structures supporting the protoser and the second-order
maps, while there are several sets of ancient sensory structures,
one per sensory modality. The participation of the ancient sensory
structures includes: a) the initiation of the process through the
influence on the structures of the protoser; b) sending signals to
second-order structures; and c) be receptors of the modulatory
influences consequent to the neural patterns of the second order.
Precisely because of this latter influence, the neural patterns that
sustain the object are enhanced and the various components of
the object to be known are integrated.
In short, central consciousness depends primarily on the activity

of a restricted number of phylogenetically ancient brain structures,
beginning in the brainstem and ending in the somatosensory and
cingulate cortices. The interaction between these structures in this
set 1) supports the creation of the protoser, 2) engenders the neural
pattern of
second order that describes the relationship between the organism

(protoser) and the object, and 3) modulates the activity of the regions
that process the object and that are not part of the whole.
The specificity with which I am identifying these places that are
prime candidates for these functions should not be interpreted as
having any one of them as the ground of consciousness. None of the
functions outlined above are performed at a single neural site or
center, but rather these functions arise as a result of interregional
integrations of neural activity. I imagine the sense of being and the
enhancement of the object as arising from the interactions of this set
of neural loci and the set of neural loci directly involved in the
construction of the object.
The neural pattern underlying central awareness for a given

object (the sense of being in the act of knowing a particular thing) is
thus a large-scale neural pattern involving the activity of two
interrelated sets of structures: the set whose interregional activity
originates the protoser and the second order maps, and the set
whose interregional activity originates the representation of the object.
Notable role overlap
Within the structures that support the protoser and the second
order maps, there is a remarkable overlapping of biological functions.
Individually, these structures are involved in most of the following five
functions: 1) regulating homeostasis and signaling the state and
structure of the body, including the processing of signals related to
pain, pleasure, and impulses; 2) participate in the processes of
emotion and feeling; 3) participate in care processes; 4) participate in

the processes of wakefulness and sleep; and 5) participate in the
memorization process.
The entire quintet of overlaps applies entirely to the brainstem
and cingulate cortices, and applies to much of the other structures.
The overlaps identified here are factual and yet have not been
highlighted before for various reasons. Perhaps the main one is that
knowledge about one of these brain regions, the brain stem, has been
divided into two different research trends, one related to the problem
of homeostatic regulation and the other related to the mechanisms of
sleep and sleep. attention. Problems and researchers have each
gone their own way. Another reason is that neuroscience's neglect of
emotion has delayed the conclusion that all of these regions, from the
brainstem to the somatosensory cortices, are central to the processes
of emotion.
Therefore, it is reasonable to conclude that, in addition to this

quintet of functions, these areas participate in an additional function:
the construction of the central consciousness.
The functional overlaps revealed by this review may seem
counterintuitive at first glance, yet after reflection on the significant
data they become perfectly plausible. In the first place, the overlaps
are surely the result of the function of different "families" of contiguous
nuclei. Second, regardless of their anatomical differences, the various
families of nuclei are closely related through anatomical connections.
Third, the anatomical contiguity and interrelationships that give rise
to functional overlap are not accidental and are surely indicative of
the dominant functional role of these regions.
The plausibility of this idea is reinforced by considering the nature

of the functional overlaps at the level of the brainstem. As far as
emotion and attention are concerned, the
rationale for functional overlap would be as follows. Emotion is critical

to properly directing attention, as it provides an automated signal
about the organism's prior experience with certain objects and thereby
provides a basis for allocating or maintaining attention in relation to a
given object. Simple organisms start their waking behavior having
basic image-making skills and a minimum of attention, with which the
following result occurs: first, object processing can occur; second, the
subsequent emotion may occur; third, there may or may not be
greater enhancement and focus of attention, driven by emotion. In
organisms capable of consciousness, the above list still applies, but
the second step should be changed to: "the subsequent emotion may
be produced and made known to the individual experiencing it."
It is expeditious, even though it is not precisely arranged in a

domestic sense, that the structures that govern attention and the
structures that process emotion are close to each other.
For certain components of these processes, the structures might
even be the same, albeit working slightly differently. In addition, it
does make sense domestically speaking that these structures are
close to those that regulate and signal the body state. The reason is
that the consequences of experiencing emotion and attention are
absolutely related to the fundamental matter of managing life within
the organism, while, on the other hand, it is not possible to manage
life and maintain homeostatic balance without data on the current
state. of the body proper of the organism in question.
Is it sensible or not that emotion and attention overlap with

central awareness? The answer is that it makes sense if we view
consciousness as the most complex means we have at our disposal
for regulating homeostasis and managing life. Nature is an expeditious
bungler and as
consciousness is a late means of achieving homeostasis, it would

have been convenient for nature to evolve the machinery of
consciousness within, out of , and in the vicinity of the previously
available machinery involved in basic homeostasis, or in other words,
of the machinery of emotion, attention, and the regulation of bodily
states.
A new context for the reticular formation and the thalamus
The above conclusions do not deny, in any way, that some of the
brain stem structures are involved in wakefulness and attention and
that they can modulate the activity of the cerebral cortex via the
intralaminar thalamic nuclei, via the non-thalamic cortical projections
of monoamines and via thalamic projections from acetylcholine nuclei.
The point is that nearby brainstem structures, and perhaps even some
of those same structures, have other activities, namely managing
body states and representing current body states. These activities are
not coincidental to the well-established activator role of the brainstem:
they may be the reason that such an activator role has been
evolutionarily maintained and that it functions primarily in that
region.
In short, I have no difficulty in acknowledging the roles that have

traditionally been attributed to the "ascending reticular activating
system" of the brainstem and its extension to the thalamus. On the
contrary, I have no doubt that the activity of these regions contributes
to the creation of the selective, unified and integrated content of the
conscious mind. I simply doubt that such a contribution is sufficient to
fully explain consciousness.
That is why I focus on a set of different, albeit related, questions: what
drives those regions to carry out the
tasks they carry out? what is the purpose of your work? To what
extent does the result of that work explain what I think consciousness
is, mentally speaking?
A counterintuitive fact?
The foregoing conclusions underscore an important fact:

Although even the simplest of central consciousnesses require
concerted activity involving regions from all parts of the brain,
consciousness depends primarily on regions that are evolutionarily
older rather than on the older ones. more recent, and of those that
are located in the depths of the brain and not so much of those that
are on its surface. Interestingly, the "second-order" processes I have
proposed here are anchored in ancient neural structures intimately
associated with the regulation of life, and not in the modern neural
achievements of the neocortex, which enable fine perception,
language, and reason. higher. That apparent 'more' of consciousness
depends on a 'less', and the second order is ultimately a low and
deep order. The light of consciousness is carefully hidden and
venerable old.
Let me point out that this is a fact and not a hypothesis: whether
or not my hypothesis is correct, the fact remains that damage to these
places impairs consciousness, while damage elsewhere does not.
The least that can be said of such a fact is that it seems
counterintuitive. We correctly think that consciousness is a significant
biological advance even when we attribute consciousness to non-
human creatures. Well, the advance is certainly significant but it may
be older than we normally think. What is not so old, evolutionarily
speaking, is the breadth of consciousness that has been allocated to
memory, in the first place, allowing us to establish an autobiographical
record; Second, by equipping us with a
broader record of other facts; and third, by giving us the power of

working memory. Surely those extensions of consciousness, which
have flourished so powerfully in humans, are based on the
evolutionarily modern aspects of the brain, namely those of the
neocortex. In the end, however, none of these striking new features
of consciousness comes about independently of the modest
achievements of central consciousness.
FOURTH PART
FORCED TO KNOW
CHAPTER NINE
FEEL SENSATIONS
FEEL SENSATIONS
I began this book by describing an obstacle: emotions cannot be

known by the subject experiencing them before there is consciousness.
Now, after presenting my views on the nature of consciousness, it is
time to explain how we can know an emotion. Starting at the beginning:
we know that we experience an emotion when the sensation of the
feeling being is created in our mind. Until there is a sense of the
sensing being, both in evolutionary terms and in the developing
individual, there are well-orchestrated responses, which constitute
emotion, and consequent representations in the brain, which constitute
a sensation.
But we only know that we experience an emotion when we feel that

the emotion is felt as given in our organism.
The sense of "given in the organism" comes from the

representation of the proto-being and its changes in the second-order
structures. The sense of "emotion as an object" comes from
representation in structures that in turn serve second-order
representations, the pattern of activity at the sites of emotion induction.
Following what was outlined for other objects, my proposal is: 1) that
the inaugural protoser is represented at a second-order level; 2) that
the "object" that is going to change the protoser (the pattern of neural
activity in the places
of emotion induction) is represented at a second-order level; and 3)

that subsequent changes in the protoser (represented by "body-loop"
or "body-loop-like" mechanisms) are also represented at a second-
order level.
Feeling an emotion is a simple matter. It consists of having

mental images that arise from the neural patterns that represent the
changes in the body and in the brain that constitute an emotion. But
knowing that we have that feeling, "feeling that feeling," comes only
after we have constructed the second-order representations necessary
for central awareness. As seen previously, they are representations
of the relationship between the organism and the object (which in this
case is an emotion) and of the causal effect of that object on the
organism.
The process I am outlining is exactly the same as the one we

have discussed for an external object, though difficult to imagine
when the object in question is an emotion, because the emotion is
within the organism rather than outside of it. The process can only be
understood when we keep in mind some of the notions presented in
the chapters on emotion (Chapter 2) and on the organism (Chapter
5), namely: 1) that there are various brain sites whose pattern of
activity induces a retinue of actions that becomes an emotion, and 2)
that the pattern of activity can be represented in second-order brain
structures. Examples of sites of emotion induction are the nuclei of
the hypothalamus, brainstem, basal forebrain, amygdala, and ventral
medial prefrontal cortices. Examples of second-order structures
include the thalamus and the cingulate cortices.
It may sound odd at first that sensations of emotion, which are

embedded in the representation of body states, only become known
after other body state representations have been integrated to give
rise to
to the protoss. And of course it sounds strange that the means to know a sensation is
another sensation. However, the sensation becomes understandable once we realize that
the protoser, the sensations of emotion, and the sensations of knowing sensations have
arisen at different points in evolution and now arise at different stages of individual
development. The protoser precedes the basic sensations, and the protoser and basic
sensations precede the sensation of knowing that constitutes the central consciousness.
THE SUBSTRATE OF THE SENSATIONS OF EMOTION
The collection of neural patterns that constitutes the substrate of a sensation arises
from two types of biological changes: changes related to body state and changes related
to cognitive state. Changes related to body state can be achieved by two mechanisms.1
One involves what I call "body looping." It uses both humoral signals (chemical messages
carried by the bloodstream) and neural signals (electrochemical messages carried by
nerve pathways). As a result of both types of signals, the landscape of the body changes
and the somatosensory structures of the central nervous system, from the brain stem
upwards, are consequently represented. The change in the representation of the body
landscape can be achieved in part through another mechanism that I call "body looping."
In this alternative mechanism, the representation of body-related changes is created
directly in the body's sensory maps
the prefrontal control ofItin
under the cortices. other
is "asneural
if" the
changed,
sites,
body has
for
even
hasexample,
really
not
thoughinit
changed. The "body-loop" mechanism bypasses the body itself, partially or
completely, and my suggestion is that skipping the body saves time

and energy, which can be useful in certain circumstances. The "like"
mechanisms are not only important in emotion and feeling but also
for a type of cognitive processes that we could call "internal
simulation."2 Changes related to the cognitive state are generated
when the emotion process takes to the secretion of certain chemicals
in nuclei of the basal forebrain, the hypothalamus and the brain
stem, with the consequent delivery of such substances to other brain
regions. When these nuclei release neuromodulators in the cerebral
cortex, thalamus, and basal ganglia, they cause a number of
significant changes in brain function. The most important alterations
that I imagine include the following: 1) the induction of specific
behaviors (such as bonding and nurturing, play and exploration); 2) a
change in the ongoing processing of bodily states (for example, bodily
signals may be filtered or passed, selectively inhibited or enhanced,
and their quality of being pleasant or unpleasant altered); and 3) a
change in the mode of cognitive processing (examples of the latter,
in relation to auditory or visual images, would be a change from slow
to fast image production rate, or a change from sharp to blurry
focused images , change that is an integral part of emotions as
disparate as sadness or joy).
I suspect that all three types of change occur in humans and

numerous non-human species. However, it is possible that the third
type of change (the change in the mode of cognitive processing) only
becomes conscious in humans because it requires a special high-
level representation of neural events: that type of meta-representation
of aspects of cognitive processing. brain that probably only the
prefrontal cortices can do.
In short, that emotional states are defined by myriad changes in

the chemical profile of the body, by changes in the state of the
internal organs, and by changes in the degree and contraction of
various striated muscles of the face, throat, trunk and extremities.
But they are also defined by changes in the collection of neural
structures that cause those changes to occur and that also cause
other significant changes in the state of the various neural circuits
within the brain itself.
To the simple definition of emotion as a transitory change

specifically caused in the state of the organism, corresponds a simple
definition of what it is to feel an emotion: it is the representation of
that transitory change in the state of the organism as a function of
neural patterns and the subsequent images. When those images are
accompanied, an instant later, by a sensation of being in the act of
knowing, and when they are enhanced, they become conscious.
They are, in the authentic sense, sensations of sensations.
There is nothing vague, slippery, or unspecific about emotional

responses, and there is nothing vague, slippery, or nonspecific about
representations that can become sensations of emotions. The
substrate for emotional sensations is a highly delimited set of neural
patterns mapped to selected structures.
From emotion to conscious sensation
In short, the entire course of events, from emotion to sensation,

and from sensation to sensation to sensation, can be broken down
into five steps, the first three of which have already been outlined in
the chapter on emotion.
1. Binding of the organism through an inducer of emotion, such as

a visually processed concrete object, resulting in visual
representations of the object.
The object may or may not be made conscious, and it may or
may not be recognized, since neither object awareness nor object
recognition is necessary for the continuation of this cycle.
2. The consequent signals to the processing of the image of the

object activate the neural places that are preset to respond to the
specific type of inducer to which the object belongs (emotion-
inducing places).
3. Emotion induction sites trigger a number of responses to the
body and other brain sites, triggering the full range of responses
from the brain and body that constitute emotion.
4. First-order neural maps of subcortical and cortical regions

represent changes in body state, regardless of whether they are
achieved via the "body loop" or "body loop-like" pathway or via
intermediate mechanisms. Feelings arise.
5. The pattern of neural activity at the sites of emotion induction is

mapped to second-order neural structures. The protoser is altered
as a result of these events. Changes in the protoser are likewise
mapped to second-order neural structures. In this way a narrative
is organized into second-order structures of ongoing events that
represent the relationship between the "object of emotion" (the
activity at the sites of emotion induction) and the protoser.
This view of emotion, sensation, and knowing is unorthodox. First

of all, what I am suggesting is that there is no central sensation state
before the respective emotion but rather that the expression (emotion)
precedes the sensation. second
Firstly, what I am suggesting is that "having a sensation" is not the

same as "knowing a sensation", that this reflection on the sensation is
still one more step. Taken together, this curious situation reminds me
of EM Forster's words: "How can I know what I think before I say it?"
The inescapable and remarkable fact about these three phenomena

(emotion, sensation, consciousness) is their relationship to the body.
We begin with an organism composed of a body proper and a brain,
equipped with certain forms of brain response to certain stimuli and
with the ability to represent the internal states caused by the reaction
to stimuli and the predetermined repertoires of responses to the
attachment to objects. As the representations of the body grow in
complexity and coordination, they become an integrated representation
of the organism, a protoser. Once that has happened, it becomes
possible to engender representations of the protoser as it is affected in
its interactions with a given environment. Only then does consciousness
begin, and only thereafter does the organism that responds most
appropriately to its environment begin to discover that yes, it is
responding most appropriately to the environment. But for their
execution all these processes (emotion, sensation and consciousness)
depend on representations of the organism. The essence they share is
the body.
WHAT ARE SENSATIONS FOR?
It could be argued that emotions without sensations would be a

sufficient mechanism for the regulation of life and the promotion of
survival. It could be argued that the signaling resulting from this
regulatory mechanism would hardly be necessary for survival. But that
is simply not the case. Having sensations is of extraordinary value for
the orchestration of survival. Emotions are useful in themselves, but
the process of
feeling begins to alert the organism of the problem that the emotion
has already begun to solve. The simple process of feeling begins to
give the organism incentives to take into account the results of getting
excited (suffering begins with sensations even if it is highlighted by
knowing, and the same can be said of joy). The availability of sensation
is also the stone of support for the next development: feeling that we
know that we have sensations. Knowing, in turn, is the foundation
stone for the process of planning specific, non-stereotyped responses
that either complement the emotion or ensure that gains through
emotion can be preserved over time, or both. In other words, "feeling"
sensations broadens the range of emotions by facilitating the planning
of new and personalized forms of adaptive response.
Consider the following: knowing a sensation requires a knowing

subject. In looking for a good reason for the persistence of
consciousness in evolution, there are worse options than saying that
consciousness has endured because organisms endowed with it could
"feel" its sensations. My suggestion is that the mechanisms that allow
consciousness may have prevailed because it was useful for
organisms to know their emotions.
And as consciousness prevailed as a biological trait, it became
applicable not only to emotions but also to the many stimuli that
triggered them. Consciousness ended up being applicable to the
whole range of possible sensory events.
A NOTE ON BACKGROUND SENSATIONS
What little attention has been paid to the neuroscience of emotion

in the 20th century has focused on the central types of emotion studied
by Darwin. Fear, anger, sadness, irritation, surprise, and happiness
have been found to be universal emotions like facial expressions and
ease of recognition, as
shows the work of Ekman and others. As a result, the sensations that
are considered most frequently are those that constitute the conscious
association of those main emotions. Which would be fine if it hadn't
distracted us from the fact that we continually experience emotional
sensations, even though those sensations are not part of the set of
six "universal sensations" that correspond to the six universal
emotions. Most of the time we don't experience any of the six
emotions, which is truly a blessing, since four of them are unpleasant.
Nor do we experience any of the so-called social or secondary
emotions, which isn't bad either, given that they're also not much
better when it comes to agreeableness. But we do experience other
types of emotion, sometimes low intensity, sometimes quite intense,
and we do notice the general physical tone of our being.
I have called the consequence of this background disturbance a

"background sensation," a term I first used in Descartes's Error
since such sensations are not in the foreground of our minds.
Sometimes we are extremely aware of them and can pay specific
attention to them.
Other times, on the contrary, we are not aware of them and pay
attention to other mental contents. In one way or another, however,
background sensations help define our state of mind and help color
our lives. Background sensations arise from background emotions,
and these emotions, though more internally than externally directed,
are observable to others in thousands of different ways: body
postures, the speed and deliberateness of our movements, and even
the tone of our voices. our voice and the prosody of our speech when
we communicate ideas that may have little to do with the underlying
emotion in question. For this reason, I think it is important to broaden
our notion of a source of sensations.
The most prominent background sensations include: fatigue,

energy, excitement, well-being, discomfort, tension, relaxation, drive,
despondency, stability, instability, balance, imbalance, harmony,
discord. The relationship between background sensations, drives,
and motivations is very intimate: drives express themselves directly
in the form of background emotions, and we can become aware of
their existence through background sensations. The relationship
between background sensations and mood is also very close. Moods
are made based on modulated and sustained background sensations
based on primary emotions; sadness, for example, in the case of
depression. Finally, the relationship between background sensations
and awareness is just as close: background sensations and central
awareness are so closely linked that they are not easily distinguishable.
It is probably correct to say that background sensations are a

faithful index of momentary parameters of the internal state of the
organism. The main ingredients of this index are: 1) the temporal
and spatial form of functioning of the smooth muscles of the blood
vessels and various organs, as well as the striated muscles of the
heart and chest; 2) the chemical profile of the environment close to
those muscle fibers; and 3) the presence or absence of a chemical
profile that poses a threat to the integrity of living tissues or conditions
of optimal homeostasis.3 Thus, even a phenomenon as simple as
background sensations depends on many levels of representation.
For example, some background sensations having to do with
the environment and the internal organs must depend on signals that
occur as primarily as the substantia gelatinosa and the intermediate
zone of each segment of the spinal cord, and the pars caudalis of
the nucleus. of the trigeminal nerve. Other background sensations
have to do with the cyclical operations of the striated muscle in
cardiac function and with the patterns of contraction or dilation of the
smooth muscles.
which requires representations in specific nuclei of the brainstem,

such as the nucleus tractus solitarus and the parabrachial nucleus.
My idea of background sensations is similar to the notion of vital

affects presented by the developmental psychologist Daniel Stern, a
notion that he uses in his work with infants. This notion was first
suggested by the notable but little celebrated American philosopher
Susanne Langer, a disciple of Alfred North Whitehead.4
THE OBLIGATED RELATIONSHIP OF SENSATION WITH THE BODY
Regardless of the mechanism by which emotions are induced,

the body is the main stage for emotions, either directly or through
their representation in the somatosensory structures of the brain. But
you may have heard that such an idea is not correct, that in essence
it was what William James proposed (in short, what James was
saying was that during an emotion the brain causes the body to
change and that the sensation of the emotion is the result of perceiving
that change of the body), and that time has discarded this theory.
First of all, there are a few more things in my proposal than what
James pointed out. Second, the attack on James, who dominated
most of his century and still stands, is simply not valid, even if his
proposed explanation of the emotions is neither irreproachable nor
complete.
The mechanisms I have outlined for representing emotions and

producing the substratum of sensations are consistent with William
James's original formulation of this topic, but provide many features
missing from James's text.
None of the features I have added undermines or violates that basic
idea that sensations are for the most part a reflection of changes in
bodily state, which is the seminal contribution of
William James to this matter. However, the new features that I bring
add a new dimension to these phenomena. Even in the course of the
most characteristic events we can find, emotional responses are
directed as much at the body proper as at the brain. The brain
produces important changes in the neural processing that constitutes
a substantial part of what is perceived as sensation. The body is no
longer the exclusive theater of emotions and, consequently, the body
is no longer the only source of sensations, as James would have liked.
Also, the body source can be virtual; so to speak, it can be the

representation "as if" it were the body instead of "being" the body. I
should add that I have not developed additional features or
mechanisms for emotion in order to be able to evade attacks on
William James's idea, although that is the case with some of my
proposals. I developed my proposals before I understood what its
detractors were attacking.
Arguably there is no need to respond to William James's critics
since his seminal idea is highly plausible, but that would be a mistake
for a number of reasons. First, the explanation offered by William
James was understandably incomplete and must be expanded in
modern scientific terms. Second, part of the explanation that was
complete was not correct in all its details. For example, James relied
exclusively on representations occurring in the internal organs,
dismissed the skeletal muscles as sources of representation of
sensations, and made no mention of the internal environment at all.
Current evidence seems to indicate that most sensations are probably
supported by all these sources: skeletal and visceral changes, as well
as changes in the internal environment. The third reason is that the
misconceptions that are part of the critique and continue to be cited
get in the way of a full understanding of emotion and sensation.
Emotion and sensation after sectioning the spinal cord
The idea that the information sent by the body is not significant
for sensations is often based on the false notion that patients with
severed spinal cords due to an accident should not have emotions or
sensations. The problem, critics say, is that they do seem capable of
experiencing emotions and sensations. However, only part of the
information from the body that is most relevant to sensations travels
through the spinal cord. First, a considerable part of meaningful
information actually travels along nerves such as the vagus, which
enter and leave the brain at the level of the brainstem, well above the
highest level of the spinal cord that can be damaged by a stroke.
accident. Similarly, only part of the representation of emotions
depends on the spinal cord: an important part of the process is
mediated by the cranial nerves at the level of the brain stem (which
can act on the face and internal organs) and by other nuclei. of the
brain stem (which can act directly on the brain above its own level).
Second, a significant part of the body's information does not

actually travel through the nerves but through the bloodstream,
reaching the central nervous system at the level of the brain stem, for
example, the area postrema or higher.
Third, all examinations of spinal cord injured patients, including
those that appear to be biased to find impaired sensation and those
that are openly biased to find that sensation is still intact, have
revealed some impairment of sensation. , as might be expected, since
the spinal cord is a partial conduit for meaningful information from the
body.5 In addition, an incontrovertible fact has emerged from these
studies: the higher up the spinal cord the damage occurs, the more
impaired the spinal cord is. sensation. This is important, because the
higher the cut is made in the
spinal cord less information from the body will reach the brain. The
higher sections should be associated with less feel, and the lower
sections with more feel. The discovery would be difficult to explain
were it not for the fact that certain information from the body is in fact
disabled by the spinal cord injury. (Although it could be argued, not
very convincingly, that high spinal cord injuries would cause greater
mobility defects and this would be accompanied by greater
psychological defects and, therefore, less sensation.)
Fourth, sections of the spinal cord are rarely complete, thus

allowing escape routes to the central nervous system.
Fifthly, some of the critics seem to conceive of the body as the

part of the organism that remains from the neck down, forgetting
about the head without further ado. What actually happens is that the
face and skull, as well as the oral cavity, tongue, pharynx, and larynx
(the combination of which makes up the upper respiratory and
digestive tracts, as well as most of the vocal system) ) provide the
brain with an enormous amount of information.
This information enters the brain at the level of the brain stem, that
is, also above the lesions in the spinal cord.
Since most emotions are expressed primarily through changes in the
facial musculature, changes in the throat musculature, and autonomic
changes in the skin of the face and scalp, the representation of brain-
related changes does not require the brain at all. spinal cord and
remains available as a basis for sensation, even in patients with the
most total forms of spinal cord severing.
In conclusion, under normal circumstances we use the spinal

cord to represent a part of some emotions and also to send signals
back to the brain about a part of the representation of those emotions.
Therefore, even the most complete cut of the spinal cord does not
interrupt the double flow of
signals required by emotions and sensations. The fact that some

defect is found in cases of spinal cord injury supports the idea that
bodily information is significant for experiencing emotion and
sensation: such a defect cannot be used to argue otherwise. But no
one should expect Christopher Reeve to be without emotions and
sensations after his accident.* The fact that he has both is not
evidence against the primary role of the body in emotions and
sensations.
Tests from the section of the vagus nerve and the spinal cord
Evidence from severing the vagus nerve or vagus nerve and

spinal cord has also been misunderstood since W. Cannon made CS
Sherrington's experiments with dogs and his own experiments with
cats the centerpiece of the attack on James in 1927.6 Cannon's
argument is an example of the confusion that occurs when what is
external, such as emotion, is not distinguished from what is internal,
such as sensation.
Why should a dog or cat suffer a complete loss of emotional display
from vagus nerve and spinal cord severing as Cannon had predicted?
You don't have to. Cutting the vagus nerve and spinal cord does not
interrupt the response pathways that alter the animal's face, such as
when experiencing anger, fear, or peaceful collaboration with the
scientist. Those responses come from the brain stem and through the
mediation of cranial nerves, which were not affected in Sherrington's
or Cannon's experiments. Those facial expressions were left intact
after making combined cuts to the vagus and spinal cord, which is to
be expected. The dogs responded with fury by showing the cats and
vice versa, even unable to move their bodies, paralyzed from the neck
down. (By the way, if those animals had been stimulated
electrically in the proper brain locations would have exhibited a phenomenon known as
"false rage," an unmotivated display of angry expressions.)
But what about the sensations of the animal? They couldn't be verified, of course,
but based on the ideas I've proposed, those sensations would probably be altered in
part: the animals would receive signals from their facial expressions and would have
intact the signaling from the nuclei of the brain stem, which would be the basis for the
sensations, although without receiving information from the internal organs that would
have been based on the signals obtained from the vagus nerve and the spinal cord. At
that moment, Cannon commanded prudence to gargle and wondered if the sensations
were far away, considering the emotional display obtained. He took the presence of
emotion as a sure sign of the presence of sensation. The error lies entirely in the inability
to make a principled distinction between emotion and sensation and to recognize the
sequential and unidirectional chaining of the process: starting from the inducer, going
through the automated emotion and the representation of the emotional changes to
arrive at the sensation.
Lockdown Syndrome Lessons
One of the most intriguing, albeit indirect, lines of evidence for the importance of
bodily information in generating sensations comes from the locked-in syndrome.
As discussed in Chapter 8, entrapment occurs when a part of the brainstem, such as the
pons or midbrain, is damaged anteriorly, on the ventral side, and not posteriorly, on the
dorsal side. The motor pathways that carry signals to the skeletal muscles are destroyed
and only a single pathway for vertical eye movement is spared, and not always
completely. The lesions causing the closure are located directly in front
to the area whose injury causes coma or persistent vegetative state

and yet patients in confinement have intact consciousness.
They cannot move a single muscle of the face, limbs, or trunk, and
their ability to communicate is often limited to vertical eye movements,
sometimes just one eye. But they are still awake, alert and aware of
their mental activity. The voluntary blinking of these patients is their
only means of communication with the outside world. Using a blink to
indicate a letter of the alphabet is a laborious technique with which
lockdown patients compose words, phrases, and even books, slowly
dictated (one should say blinking) to an attentive scribe.
One notable aspect of this tragic situation, and one that has been
slow to date, is that although the patients have passed, fully conscious,
from a state of human freedom to one of complete mechanical
imprisonment, they do not experience the anguish and confusion that
their horrific situation would cause. wait for viewers. They experience
a wide range of sensations, from sadness to, yes, joy. And yet,
according to accounts now published in book form, patients may even
experience a strange tranquility that is new to their lives. They are
fully aware of the tragedy of their situation and may report an
intellectual sense of sadness or frustration at being imprisoned in life.
But they do not say they have that terror that we imagine would attack
us in their terrible circumstances.
They do not seem to have anything like the acute fear that many
perfectly healthy and mobile individuals experience inside an MRI
scanner, let alone a crowded elevator.7 My way of explaining this
startling discovery is as follows: Next. Leaving aside the blinks and
vertical movements of the eyes, the damage of the confinement
precludes any movement, voluntary or represented by emotional
responses, of any part of the body. facial expression and gestures
bodily movements in response to deliberate intention or emotion are

disabled (there is one partial exception: tears may be produced but
the motor accompaniments of crying are absent). Under these
circumstances, any mental process that would normally induce an
emotion cannot induce it via the "body-loop-like" mechanism we have
examined. The brain is deprived of the body as the theater of
emotional materialization. However, the brain can still activate the
emotion-inducing sites of the basal forebrain, the hypothalamus, and
the brainstem, and generate some of the internal brain changes on
which sensations depend. In addition, since most of the body's
signaling systems to the brain are free and clean, the brain can get
neural and chemical signals from the body's profile that match
background emotions. These profiles are related to basic regulatory
aspects of the internal milieu and are largely disconnected from the
patient's mental state due to brainstem damage (only chemical
pathways in the bloodstream remain open both ways). My suspicion
is that part of the states of the internal environment are perceived as
calm and harmonious. Support for this idea comes from the fact that
when these patients experience a situation that should cause pain or
discomfort, they are still able to register it. For example, they feel
numb and stiff when they have not been moved for a long time.
Curiously, the suffering that usually follows pain seems duller, perhaps
because the suffering is caused by an emotion and the emotion can
no longer be produced in the bodily theater: it is restricted to "as"
mechanisms.
Another line of evidence that corroborates this interpretation

comes from patients who undergo surgery and receive an injection of
curare, a substance that blocks the activity of skeletal muscles by
acting on nicotinic acetylcholine receptors. If the curare acts before
induction due to anesthesia suspends consciousness, patients are
aware of his paralysis. Like patients with lockdown syndrome, cured

patients are able to hear the conversations of those around them.
Based on post-event reports, these patients appear less calm than
locked-in patients and more like one imagines they would react in
such a situation. There may be a clue that explains the difference.
Curare blocks nicotinic acetylcholine receptors, the transmitter
necessary for nerve impulses to contract muscle fibers. Since the
skeletal muscles of our entire face, limbs, and trunk are of the striated
type and have these nicotinic receptors, curare blocks neurochemical
impulses at the site of neuromuscular junctions, causing paralysis.
However, the nerve impulses that cause the smooth muscle response
under the autonomic control of emotions use muscarinic receptors
that are not blocked by curare. In these circumstances, it is possible
that a part of the emotional responses, which depend on purely
autonomic signals, are represented in the theater of the body and
then re-enacted in the neural structures.
Taken together, this evidence seems to indicate that the "body-

loop" mechanism of emotion and sensation is of greater importance
to the actual experience of sensations than the "body-loop-like"
mechanism that I have proposed as an alternative and complement.
Memorization from emotion with the help of the body
A recent series of experiments on memorization also provides

evidence for the body's role in emotion.
It has been shown, in both rats and humans, that recollection of new
facts is enhanced by the presence of varying degrees of emotionality
during learning. James
McGaugh and his collaborators have conducted such studies

whose results are now well confirmed.8 For example, if we are
told two stories of similar length and number of similar events,
differing only in that in one of them the events have a strong
emotional charge, we will remember many more details of the
emotional story than of the other. You may like to know that we
have this in common with rats when they are placed in an
equivalent situation. They, too, are more successful in a standard
learning situation when a certain degree of emotionality is in
place at the right time. Now, once the rats' vagus nerve is
severed, emotion no longer helps them learn. Why? Well,
because without the vagus, the rats are also deprived of the
substantial information that reaches the brain from the internal
organs. It has to be because the information that is now missing
from those particular organs is vital for that kind of emotion that
aids memorization.
CHAPTER TEN
THE USE OF CONSCIOUSNESS
UNCONSCIOUSNESS AND ITS LIMITS
Those who engage in reflection on the problem of consciousness

increasingly agree that consciousness is valuable and that it persisted
in evolution precisely because of its value. However, there is less
agreement when trying to specify the contribution that consciousness
has made.
I began this book by drawing attention to the unconscious nature
of emotions and showing how effective emotions and sensations can
be, even when organisms are unaware of their existence. It is
therefore reasonable to ask, what possible advantage can organisms
derive from knowing that such emotions and sensations are taking
place? Why is awareness beneficial? Would we have been equally
successful as living creatures had we not known that we had
sensations?
I began by addressing these questions in the previous chapter,
but a more detailed answer requires pondering the power and limits
of unconscious processing. It goes without saying that both the
thoughts we hold in our minds and the behavior we display are the
result of an enormous amount of processing that we are not aware
of. The influence of unknown factors on the human mind has long
been recognized. In ancient times, unknown factors were called gods
and fate. At the beginning of the 20th century, the unknown factors
approached our being and began to be located in the
underground of the mind In the version that is generally identified with

Sigmund Freud, the functioning of this underground would be shaped
by a determined set of early individual experiences. In another
version, that of Carl Jung, the conformation of this subterranean
would have begun evolutionarily a long time ago. We do not need to
accept the mechanisms proposed by Freud or Jung to recognize the
existence of unconscious processes and recognize their power in
human behavior. Throughout the century, and through works that are
unrelated to the original proposals of Freud and Jung, evidence of
this unconscious processing has not ceased to accumulate.
The field of social psychology has provided abundant evidence

of nonconscious influences on the human mind and behavior. The
compelling examples are too numerous to list, but the comprehensive
reviews by J. Kihlstrom and A. Reber provide good access to these
fascinating facts.1 Cognitive psychology and linguistics have provided
their own convincing evidence.2 For example, toward By age three,
children make amazing use of the construction rules of their
language, but they are unaware of such "knowledge" any more than
their parents are. A good example is provided by the way three-year-
olds perfectly form plurals:
dog [dog] + plural = dogz

cat [cat] + plural = cats
bee [bee] + plural = beez
Children add the voiced z or silent s to the end of the appropriate

word, but whether they select one or the other does not depend on a
conscious exploration of their knowledge. The selection is unconscious.
The knowledge of the grammatical structure, pointed out to us by
Noam Chomsky towards the middle of the 20th century, is not aware
in most cases of correct and efficient use.3
Examples from the field of neuropsychology are equally numerous

and compelling. For example, knowledge gained through conditioning
remains outside of conscious exploration and is expressed only
indirectly; patients who can no longer recognize faces consciously
may detect familiar faces unconsciously; completely blind patients
due to brain injuries are able to point quite accurately to a light source
that they cannot consciously see.4 The recovery of sensorimotor
abilities expressed in movement, without awareness of such
knowledge, provides a good insight into this situation.
The term sensorimotor skill refers to what we acquire by

learning to swim, ride a bicycle, dance or play a musical instrument.
The learning of such skills supposes multiple executions throughout
which the performance of the task is perfected. You don't learn to
play the violin in one lesson, even if you are a new Heifetz. Many
lessons are needed. On the other hand, you can learn my face and
my name in one fell swoop.
There are reliable tasks to measure learning ability in the

laboratory, such as mirror tracing or rotor chasing.
In the latter, for example, the subject is asked to keep the point of a
needle in contact with a tiny dot, painted on the edge of a circular
disc, while the disc rotates at high speed.
It takes time and several tests to be able to do it well, which consists
of going at the same rhythm as the circular movement of the disk.
Good coordination between the speed of the puck and the speed of
arm movement is required. A computer automatically measures
performance by noting how long the needle tip actually spends in
contact with the dot.
Healthy individuals master this task in a few sessions, and when
we plot test measures over sessions, we realize that a learning curve
occurs. The next session always gives fewer errors than the previous
session.
above and it shortens the time needed to complete the task. In this
way normal subjects are learning a number of things at the same
time. They learn about the site and the people running the experiment,
they learn about the apparatus that is needed for the experiment,
they learn the instructions for the task, and they learn to do that task
better and better. As our mother always told us, practice makes
perfect until we can't get any better: practice takes us straight to
Carnegie Hall.* Now let's repeat the experiment but changing the
participants, specifically for patients with severe amnesia, like David,
who cannot memorize new faces, words, situations or places.
One would expect that these patients would not be able to learn the
task, but this is not the case. They learn it perfectly and its execution
does not differ in any way from that carried out by normal subjects.
However, there is an essential difference between David, on the one
hand, and normal subjects, on the other: and it refers to what
surrounds the task and not so much to the task itself. Amnesic
patients do not memorize anything at all regarding the place, the
people, the apparatus and the instructions of the experiment. The
only thing they learn is the execution of the task and they need to be
told, always gently, what the task consists of, each time they face
the apparatus. That they do it and do it better and better, with fewer
errors and faster, is a clear indication that the deployment of the skill
does not depend on the conscious study of the facts that describe it.
David doesn't remember what he thought about the difficulties he ran

into in the first few sessions, nor does he remember what he thought
about how to improve task performance and refine skill. It is limited
to execute it skillfully. For him, as a conscientious person, it is as if
he were approaching the situation for the first time. And yet outside
of that conscious approach to the instructions and knowledge of the
skill, your brain is primed to deploy the skill.
No less remarkable is a fact that we were able to show in these

patients as well: knowledge of the skill persists long after it is acquired.
For example, David was still able to do the task at the same level as
the control tests two years after teaching him. Which indicates that
the knowledge was consolidated.
It could be argued that while such nonconscious skillful execution

is interesting, it is of no value to patients and not meaningful to normal
individuals. After all, we usually know the circumstances in which we
learn a skill and the events associated with learning. But the fact that
sensorimotor skills can be deployed without study, or with little
conscious study, is highly advantageous in the performance of many
small and not-so-small tasks in our daily lives. The lack of reliance on
conscious study automates a substantial part of our behavior and
frees us up, leaving us with attention and time (two useful things that
are scarce in our lives) to plan and execute other tasks and create
solutions to new problems.
Automation is also very valuable in specialized motor executions.

A part of the technique of a good musician or athlete may remain
below consciousness, allowing the performer to concentrate on higher
guidance and control of one's own technique in order to carry out the
performance according to the performance. specific intention of a
certain piece.
When a face-agnostic patient (such as Emily, the patient I

examined in Chapter 5) is randomly shown the faces of people she
has never met along with the faces of close relatives and friends, her
conductance is recorded. of the skin at the same time, a drastic
dissociation occurs. To your conscious mind, the faces are all equally
unrecognizable. Friends,
relatives and true strangers create the same emptiness and there is
nothing that comes to mind that allows you to discover your identity.
And yet, the presentation of virtually all faces of friends and relatives
elicits a distinctive skin conductance response, which unfamiliar faces
do not. The patient does not notice any of these responses. And
furthermore, the magnitude of the skin conductance response is
greater for closer relatives.
The interpretation is unequivocal. Instead of being unable to

consciously evoke knowledge in the form of images in a way that
would allow recognition, the patient's brain is still able to produce a
specific response that occurs outside the conscious field and reveals
prior knowledge of that particular stimulus. The discovery illustrates
the power of nonconscious processing, the fact that specificity can
exist below consciousness.
Perhaps the most compelling example of higher-level

nonconscious processing comes from work done in my lab in
collaboration with Antoine Bechara and Hanna Damasio. The work
requires a decision-making task and reveals that many of the
decisions that can be reached using logic and relevant knowledge
are facilitated by unconscious influence before knowledge and logic
play their full roles. It also reveals that emotions play an important
role in driving nonconscious signals. The task is based on a card
game in which, unknown to the player, some piles are good and some
are bad. The knowledge of which ones are good or bad is acquired
gradually, as the player removes card after card from the different
piles. The source of the knowledge is the fact that drawing certain
cards from certain piles has financial rewards or penalties.
We began using this task to investigate decision-making in frontal

lobe-injured patients and more recently have used it to investigate
emotions and consciousness in both brain-injured patients and
healthy individuals without neurological disease.
When normal players start picking over and over again from the
good piles and start avoiding the bad ones, they don't yet have a
clear and conscious idea of the situation they are facing, nor have
they formulated a conscious strategy of how to deal with it. However,
by this time, your brain is already starting to produce systematic skin
conductance responses just before you select a card from the bad
piles. These responses are indicative of an unconscious bias,
evidently connected with the relative goodness or badness of the
heaps. The fundamental question is how the brain 'comes to know',
without consciousness, that some heaps are good and others are
bad. In the restricted sense of knowing, the brain does know the
following: that things that are rewarded give rise to pleasant states,
that things that are punished give rise to unpleasant states, that for
the same reason a certain object that is a continuing source should
be avoided. as punishment. In this scenario, there is no need to make
the facts of past experience conscious. They do have to be connected
by the appropriate neural patterns to the current situation so that their
predetermined influence can be exerted as a covert bias.5 And yet
conscious humans can go beyond the processing state that has been
described. Humans can not only be aware of such tendencies, for
example, in a broad sense, but can also reach the appropriate
conclusions through conscious reasoning and use those conclusions
to avoid unpleasant decisions.
From patients who lose this covert bias system (patients with
damage to the ventral medial prefrontal cortex or amygdala) we know
that the decision apparatus
he is impoverished to a dramatic extreme. This indicates that the non-

conscious system is deeply interwoven with the reasoning conscious
system, in such a way that the interruption of the first leads to a
deterioration of the second. But in the situation of a person with
neurological disease, where both the nonconscious and conscious
systems are present and normal, it is clear that the conscious
component extends the reach and effectiveness of the nonconscious
system. Awareness allows the player to discover if his strategy is
correct and, if it is not, allows him to correct it. In addition, awareness
allows the player to represent the context of the game and decide
whether to stop the game or wonder about the possible value of the
situation for himself or for the examiner.
THE MERITS OF CONSCIENCE
What is consciousness really worth, considering that all vital

regulation can be achieved without conscious processing, that skills
can be automated and preferences can be internally represented
without the intervention of the knowing being? The simplest answer:
consciousness works to extend the reach of the mind and, therefore,
to improve the life of the organism whose mind has that greater reach.
Consciousness is valuable because it introduces a new means

of achieving homeostasis. I am not referring to a more efficient means
of balancing the internal milieu than the completely non-conscious
machinery that we have long had in place in our brainstem and
hypothalamus. I am referring to a new means of solving different
kinds of problems, which, however, are connected with the problems
of homeostatic regulation solved by previously existing means. In
other words, brainstem and hypothalamic devices can nonconsciously
and very efficiently coordinate the workings of the heart,
the lungs, the kidneys, the endocrine system, and the immune system
in such a way as to maintain the parameters that allow life within the
proper range, while the devices of consciousness are dedicated to
solving the problem of how an individual organism can cope with the
environmental challenges that are not foreseen in the basic design in
such a way that the fundamental conditions of survival can continue
to be met.
A fact compatible with this conclusion is the mismatch between

the demands of the environment and the degree of response that
organisms can give with their automated and stereotyped devices.
Non-sentient creatures are capable of regulating homeostasis
internally and equally capable of breathing air, finding water, and
obtaining the energy required for survival within the type of
environment for which evolution has prepared them. Creatures with
consciousness have some advantages over those without. They can
establish a link between the world of automatic regulation (the world
of basic homeostasis that is interwoven with the protoser) and the
world of imagination (the world in which images from different
modalities can be combined to produce new images of situations that
have not yet arisen). The world of imaginary creations (the world of
planning, formulating situations and predicting results) is linked to the
world of the protoser. The feeling of being links anticipations, on the
one hand, and pre-existing automatisms, on the other.
Consciousness is not the only means of generating adequate

responses to an environment and thus achieving homeostasis.
Consciousness is only the latest and most complex means of doing it
and performing its function by opening the way to the creation of new
responses in that kind of environment for which the organism was not
designed, as far as its automated responses are concerned.
I would say that, as consciousness is designed, it limits the world

of the imagination to be first and foremost about the individual, about
the individual organism, about being in the broad sense of the term. I
would say that the effectiveness of consciousness comes from its
unabashed connection to the non-conscious proto-self.
It is the connection that creating a concern ensures that proper
attention is given to the issues of individual life. Perhaps the secret
behind the effectiveness of conscience is self-care. In short, the power
of consciousness comes from the effective connection it establishes
between the biological machinery for regulating individual life and the
biological machinery for thought. That connection is the basis for the
creation of an individual concern that permeates all aspects of thought
processing, focuses all problem-solving activities, and inspires
subsequent solutions. Consciousness is valuable because it centers
knowledge about the life of the individual organism.
Evidence of the value of conscience comes from considering the

results that even its slightest impairments produce.
When the mental aspect of being is suspended, the advantages of
consciousness soon disappear. Vital regulation ceases to be possible
in a complex environment. In the full personal and social sense,
individuals remain capable of basic and immediate bodily maintenance.
But their connection with the environment on which they depend is
interrupted, and because of that interruption, they cannot carry out
such bodily maintenance. The truth is that if they were left to their own
devices, death would come to them in a matter of hours because that
bodily maintenance would collapse. This and comparable examples
seem to indicate that the state of consciousness encompassing the
sense of being as conceptualized in this book is indispensable for
survival.
The iconic level of "being in the act of knowing" is advantageous

to the organism because it orients the entire apparatus of behavior
and cognition toward self-preservation, as Spinoza would have
desired, and ultimately toward collaboration with others. as we should
wish.
WILL WE EVER EXPERIENCE ANOTHER PERSON'S CONSCIOUSNESS?
I am often asked if, as a result of our growing understanding of

consciousness, we will end up gaining access to the mental
experiences of others. My answer to the question has long been no
and I have not changed my mind. This may seem surprising at first
glance, given the amount of new things we are learning about
neurobiology. However, as I see it, no amount of knowledge about
the biology underlying mental images is likely to produce in the mind
of the possessor of such knowledge the equivalent of the experience
of any mental image in the mind of the organism that creates it.
Let's imagine that in a future that may not be too far away, a
wonderful new scanner allows you to explore my brain in
unprecedented depth as I look out over, say, the San Francisco Bay.
There we are all: you, me, the wonderful scanner and the San
Francisco Bay. The scanner will not only focus on what is already
available today, ie large-scale systems, but much more in depth.
Imagine, for example, that you can scan my retinas, lateral geniculate
nuclei, and all the early visual cortical regions, separately and at
different times, during the construction of the visual image that I am
forming of what is in front of me. Even more, imagine that the scan
can take you to the different cell layers of the various cerebral cortices
and subcortical nuclei and that the resolution
Space is so good that you can clearly see patterns of neuron firing
that correspond to things that you and I can see outside of our bodies.
Imagine, finally, to take the situation outside the current limits but not
outside the plausible, that your wonderful scanner also provides you
with a description of the physics and chemistry of the patterns of
neural activation that you detect in my various sets of neurons.
Armed with all this data from such powerful scanners, and
assuming you have equally powerful computers to analyze the
enormity of data in ways that yield meaningful results, you might well
come up with a remarkable set of correlates of the content of the
image I have in mind. What I am telling you, however, is that you will
not have gotten my experience of that image in any way. This is a
key aspect to clarify any discussion of the neurobiology of
consciousness and mind. You and I may have an experience of the
same landscape, but each of us will generate that experience
according to our own individual perspective. Each of us will have a
different sense of what belongs to him individually and what he does
individually. When you look at the patterns of my brain activity that
underlie my personal experience of the San Francisco Bay you will
be having your own personal experience of all that neural data but
not my experience of the San Francisco Bay. You will experience
something closely related to my experience but it is a completely
different experience. You don't see what I see when you look at my
brain activity. What you see is a part of my brain activity when I
see what I am seeing.
My own experience of the landscape comes to me easily, freely

and directly, without the need for any technology to intervene.
I don't need to know anything about the behavior of neurons and
molecules in different parts of my brain to be able to experience the
San Francisco Bay. In fact, even
when I recall to myself all the knowledge of neurophysiology related

to the mental formation of visual images of landscapes, there is not
the slightest difference in the formation of these images or in my
experience of them. It's nice to have some idea of how the brain
works, but it's not at all necessary to experience anything. And it
would even be nice to know more about the brain, but not because it
is useful for having experiences of the world.
Therefore, the matter should be made very clear: we will know
more and more about the physiology of processing mental images
and this will provide us with an ever better understanding of the
mechanisms underlying the mind and consciousness. Which is
perfectly compatible with the fact that such knowledge is not at all
necessary to have the experience of any image.
Then another problem arises. The fact that knowledge of the

biology of image processing is irrelevant to the experience of those
images is often understood to mean that the biology underlying those
images cannot be discovered without further ado. Of course, the
previous claim has nothing to do with this one. We have already seen
that our knowledge of and experience of the biological mechanisms
underlying image formation is one thing, and our experience of those
images is another. As far as we can fathom, no amount of knowledge
about the neurophysiology of mental image formation and experiencing
will ever produce the experience of such mental images in those who
possess such knowledge, although more knowledge will give us a
more satisfactory account of how. we get to have those imagery
experiences.
Philosopher Frank Jackson presented a story about this problem

that has become fairly well known in philosophical circles and is often
cited in discussions of the subject.6 The story tells of Mary, an
eminent neuroscientist who has grown up in a closed environment, in
black and white, unexperienced
colors, although he knows all the facts and facts about the
neurophysiology of vision. One day, Mary leaves her colorless cocoon,
goes out into the real world and experiences color for the first time,
something completely new and surprising for her. The first and
traditional moral of the story is that Mary's superior knowledge of the
neurophysiology of color was never able to give her the experience
of color. Until then, okay. It is not surprising that I agree that this is
the case, based on what I have explained above. Now let's turn to the
second moral of the story, the main one, which I cannot agree with:
the fact that Mary has never experienced color despite all her
abundant knowledge of its biological basis is taken to mean that
neurophysiological knowledge does not can be used to explain mental
experience, that there is a scientifically unbridgeable chasm between
knowledge and experience.
I do not agree with these conclusions for different reasons. First

and foremost, explaining the mechanisms underlying an experience
and having the experience are entirely different matters, as the little
science fiction with which I began this section illustrates. We should
not conclude that neurophysiological knowledge is not adequate to
explain the phenomenon just because having such neurophysiological
knowledge is not the same as experiencing the phenomenon we are
trying to explain. It shouldn't be and it can't be.
The second reason for disagreement follows the arguments I have

presented earlier. The experience of a certain stimulus, color, for
example, does not depend only on the formation of an image but also
on the sensation of being in the act of knowing. Mary's fable is
inadequate for this purpose because it does not deal
neurophysiologically with her experience of color but simply with her
formation of a color image.7 But of course Mary could have known
the neural basis of consciousness. I could have read this book.
At that time, she would have known how to explain the mechanisms
of the mental experience of color, although this would not have

allowed him to have an experience of color. Explaining how to do
something mental or our own in scientific terms is a totally different
matter from doing something mental and ours directly.
The resistance found in some scientific strongholds to the use of

subjective observations is a renewal of the old dispute between
behaviorists, who believed that only behaviors and not mental
experiences could be studied objectively, and cognitivists, who
believed that studying only the behavior did not do justice to human
complexity. The mind and its consciousness are the primordial and
most private phenomena, however much they give numerous public
signs of their existence to the interested observer. The conscious
mind and its constituent properties are real entities, not illusions, and
must be investigated as the personal, private, subjective experiences
that they are.
The idea that subjective experiences are not scientifically

accessible is nonsense. Subjective entities require, like objective
ones, that there be enough observers to make rigorous observations
according to the same experimental design; and they require that
those observations be checked for inconsistencies across different
observers and that they offer some form of measurement. Furthermore,
knowledge gained from subjective observations, for example insights,
can inspire objective experiments and, not least, subjective
experiences can be explained in terms of available scientific
knowledge. The idea that the nature of subjective experiences can be
effectively grasped from the study of their behavioral correlates is
wrong. Although mind and behavior are biological phenomena, mind
is mind and behavior is behavior. Mind and behavior can be
correlated and the correlation will become closer as science advances

but, in their respective specifications, mind and behavior are different.
So, in all likelihood, I'll never know your thoughts unless you tell me, and
you'll never know mine until I tell you.
IN WHAT GRADE OF THE GENERAL RANK IS CONSCIOUSNESS?
The confluence of so many meanings around the word

consciousness makes it almost unusable without qualification and that
confluence is surely responsible for the supreme status to which
consciousness has been elevated. This confluence has led to freely
attributing to consciousness properties of the human mind that we
consider extremely refined and exclusively human, such as our ability to
distinguish good from evil, our knowledge of the needs and wants of
human beings, our sense of of our place in the universe. This
consideration has made conscience untouchable. Instead, I see
consciousness as enabling the mind to develop the properties we so
admire, but not as the substance of those properties. Consciousness is
not consciousness.
It is not the same as love, honor or compassion, generosity and altruism,

poetry and science, mathematical and technical invention. Nor, for that
matter, are moral turpitude, existential angst, or lack of creativity
examples of bad states of conscience. In most criminals the conscience
is not impaired; maybe your conscience does.
The wondrous achievements that come from the human mind

require consciousness in the same fundamental way that they require
life and that life requires digestion and a balanced internal chemical
environment. But none of those wonderful achievements is
directly caused by consciousness. Instead, they are a direct

consequence of a nervous system that, being capable of
consciousness, is also equipped with an extremely large memory,
with the powerful ability to categorize items in memory, with the novel
ability to encode the entire spectrum of knowledge. in linguistic form
and with an outstanding ability to hold knowledge in a mental display
in order to manipulate it intelligently. In turn, each of these abilities
can be broken down into a myriad of mental and neural components.
The central consciousness is not very high on the ladder of

functions that allow human beings to be what they are. It is part of the
foundation of a complicated building: it is not one, it is the dreamy
capitals at its top. On the ladder, core consciousness ranks above,
but not far from, other foundational capacities: action, emotion, and
sensory representation, which we share with various nonhuman
species.
The essence of those foundational capabilities has surely
changed little if we compare the human version with the non-human
version. For example, I see no evidence that emotion is "enhanced"
in humans. What has become different has been our sense of the
role that emotions play in our lives and that difference is a
consequence of the greater knowledge we have of the substance of
our lives. What makes the difference is memory, language and
intelligence, not emotion.
Probably the same can be said of consciousness. Extended
consciousness occurs in minds endowed with central awareness, but
only when those minds can be supported by superior memory,
language, and intelligence, and when the organisms that build those
minds interact with suitable social environments. In short,
consciousness is a great pass for civilization but it is not civilization.
Figure 10.1. From wakefulness to consciousness.
When I lower consciousness from its current pedestal, I am not

also lowering the human mind from its pedestal. The only thing that
happens is that what has placed the human mind on its pedestal (and
must continue to keep it there) is not only the biological phenomena
that the term consciousness encompasses, but also many other
phenomena that we need to describe, name and understand
scientifically. I am however willing to admit that surely we were
expelled from Eden because of conscience. Consciousness is not the
full tasting of the fruit of knowledge, but that innocent consciousness
was the one that started it all, many species ago and many millions
of years before humans began to have ideas about their own nature.
CHAPTER ELEVEN
UNDER THE SPOTLIGHT
FOR THE SENSATION AND FOR THE LIGHT
Perhaps the most shocking idea in this book is that consciousness

ultimately begins as a sensation, a special sensation, to be sure, but
a sensation nonetheless.
I still remember when I first started thinking of consciousness as
sensation, and it still seems like a sensible reason to me:
consciousness feels like a feeling, and if it feels like a feeling, it may
well be. It certainly does not give the impression of being a clear
image of any of the externally directed sensory modalities. It is not a
visual pattern or an auditory pattern, it is not an olfactory or taste
pattern. We do not see or hear consciousness. Consciousness is
noted as a kind of pattern made from nonverbal cues of bodily states.
It may be for this reason that the mysterious source of our first-person
mental perspective (the central consciousness and its simple sense
of being) reveals itself to the organism in a way that is both powerful
and elusive, unmistakable and vague.
Malebranche, a 17th-century French philosopher , might have
approved of this explanation, since three hundred years ago he wrote:
The mind sees the essence of things, of numbers, of extensions, through light and
through a clear idea. The mind judges the existence of creatures and what it knows of
its own existence by means of a vague idea or by means of a sensation.1
The idea of consciousness as a sense of knowing is consistent

with the important fact that I have adduced regarding the structures
of the brain most closely related to consciousness: those structures,
from those that support the proto-self to those that support second-
order mappers. , process bodily signals of whatever kind, from those
of the internal environment to those of the musculoskeletal support.
All these structures work with the non-verbal language of sensations.
Therefore it is plausible that the neural patterns that arise from the
activity of these structures are the basis of the kind of mental images
that we call sensations. The secret of manufacturing consciousness
may well be the following: that the drawing of the relationship between
any object and the organism becomes the sensation of a sensation.
The mysterious perspective of consciousness, in the first person,
consists of newly minted knowledge, information, if you will, expressed
as sensation.
Presenting the roots of consciousness as sensations allows one
to glean an explanation for the sense of being, the second of the two
problems of consciousness that I outlined in the introductory chapter
(that is, how the possessor of that movie in the brain arises within of
the movie). However, the proposal does not fully address the first of
the problems then outlined: how that movie in the brain is generated
from sources of qualia. Other proposals from neurobiologists,
cognitive scientists and philosophers are directed at the first problem.
For example, Gerald Edelman's proposal, perhaps the most

comprehensive attempt to deal with the issue of consciousness
published to date, uses a striking biological framework to address the
conditions under which the movie can be generated in the brain. In
his most recent work he takes his efforts further and specifies the
physiological conditions necessary for the creation of scenes
embedded in the conscious mind. other attempts to
Addressing aspects of the movie-in-the-brain problem may be Bernard

Baars' global workspace hypothesis and Daniel Dennett's multiple
drafts model.
The important thing is that by making sensations the ancestors
of consciousness, we are forced to ask ourselves about the intimate
nature of sensation. What are sensations made of? What are
sensations perceptions of? To what extent can we go beyond
sensations? These questions cannot be fully answered at this time.
They define the limit of our current scientific investigation.
However, whatever the answers, the idea that human

consciousness depends on sensations helps us deal with the problem
of creating conscious artifacts. Can we create an artifact with
consciousness with the help of advanced technology and
neurobiological facts? It may not be surprising that, given the nature
of the question, you have two answers to it: one is yes and the other
is no. No, we have little chance of creating an artifact that has
anything remotely like human consciousness, conceptualized from
an internal sensation perspective. Yes, we can create artifacts with
the formal mechanisms of consciousness that have been proposed in
this book, and it may be possible to say that such artifacts have some
kind of consciousness.
Some external behaviors of artifacts with formal mechanisms of

consciousness will be similar to conscious behaviors and may well
pass a version of the Turing test for consciousness. But apart from all
the good reasons that John Searle and Colin McGinn have put
forward on the matter of behavior, mind, and the Turing test, passing
it does little to guarantee that the artifact has a mind. More specifically,
the internal states of the artifact may even be similar to some of the
mental and neural blueprints that I have proposed here as the basis
of consciousness. They would have the way to generate second-order
knowledge, but by not
Having the help of the non-verbal vocabulary of sensation, knowledge

would not be expressed in the way we see in humans and that surely
exists in so many living species. Indeed, the barrier is sensation
because the materialization of human consciousness may require
the presence of sensations. The "look" of emotion can be simulated,
but sensations cannot be duplicated in silicone. The sensations
cannot be duplicated unless the meat is duplicated, unless the
actions of the brain on the meat are duplicated, unless the sensation
of the meat in the brain is duplicated after the brain has acted on it.
UNDER THE SPOTLIGHT
I began this book by invoking birth and the moment of going

onstage, into the light, as suggestive metaphors of consciousness.
When we come to be and from then on, two thirds of each day lived,
without pause, we expose ourselves to the light of the mind and are
known to ourselves. And now that the memory of so many futures
has made us the people we are, we can even imagine ourselves
going on stage and exposing ourselves to the spotlight.
Everything begins modestly, with the most naked senses of our

living being relating to some simple thing inside outside the borders
of our body. Then the intensity of the light increases and as it shines
brighter, a greater portion of the universe is illuminated. More objects
than ever from our past can be clearly seen, first separately, then at
the same time; more objects in our future, and more objects around
us, are brightly illuminated. In the growing light of consciousness,
more and more things are becoming known every day, more and
more precisely, and all at the same time.
From its humble beginnings to its present state, consciousness is

a revelation of existence: a partial revelation, I might add. At some
point in its development, with the help of memory, reasoning and,
later, language, consciousness also becomes a means of modifying
existence.
When we begin to manipulate existence guided by the partial

revelation of that existence, the entire human creation returns to that
transition point. We only create the sense of right and wrong, and the
norms of conscious behavior once we know our own nature and that
of others who are like us. Creativity itself (the ability to generate new
ideas and artifacts) requires much more than consciousness can
provide. It demands a lot of memory of facts and skills, abundant
working memory, refined reasoning ability, language. But consciousness
is always present in the process of creativity, not only because its light
is indispensable, but also because the nature of its revelations guide
the process of creation, in one way or another, more or less intensely.
It is curious that whatever we invent, from ethical norms to science
and technology, everything is directly commanded or inspired by the
revelations of existence that consciousness offers us. Furthermore,
and in one way or another, more or less, these inventions have an
effect on existence when they are revealed, for better or worse. There
is a circle of influence (existence, consciousness, creativity) that is a
closed circle.
The drama of the human condition comes only from consciousness.

Of course, consciousness and its revelations allow us to create a
better life for ourselves and for others, but the price we pay for that
better life is high. It is not just about the price of risk, danger and pain.
It is the price of knowing risk , knowing danger , knowing pain .
Worse still: it is the price of knowing what pleasure is and of knowing

when it is lost or unattainable.
The drama of the human condition thus comes from consciousness

because it refers to the knowledge obtained in a bargain that none of
us has made: the cost of the best existence is the loss of innocence
about that very existence. The feeling of what is happening is the
answer to a question that we have never asked, and it is also the
currency of a Faustian deal that we have never agreed to. Nature has
done it for us.
But drama does not necessarily mean tragedy. To a certain extent
and in very different imperfect ways, individually and collectively, we
have the means to guide creativity so that, in doing so, we improve
human existence instead of worsening it. It is not easy to get; there
are no tracks we can follow; successes may be small, failure is likely.
And yet, if creativity is successfully guided, however modestly, we will
once again allow consciousness to fulfill its homeostatic and regulatory
role on consciousness. Knowing will help to be. I even have some
hope that understanding the biology of human nature will help make
the right choice. Be that as it may, the improvement of existence that
has fallen to us is precisely what civilization consists of, that main
consequence of consciousness, and what it has been trying for at
least three thousand years with better or worse results.
So the good news is that at least we've already started.

APPENDIX
NOTES ON THE MIND AND THE BRAIN
ASSORTED GLOSSARY
Because words such as images, neural patterns,

representations , and maps have a variety of unclear meanings,
their use is fraught with difficulties. However, those words are
indispensable to conveying one's ideas in any attempt to engage
ideas with the issues in this book.
These notes are intended to further clarify my use of some of these
words.
What is an image and what is a neural pattern?
When I use the term image I always mean mental image.

Synonym of image is mental pattern. I do not use the word image to
refer to the pattern of neural activities that can be found, with the
current methods of neuroscience, in the activated sensory cortices,
for example in the auditory cortices in correspondence with an
acoustic perception, or in the visual cortices in correspondence with
an acoustic perception. correspondence with a visual perception.
When I refer to the neural aspect of the process I use terms such as
neural pattern or map.
Images can be conscious or non-conscious (see following
pages). Non-conscious images are never directly accessible.
Conscious images can only be known from the perspective of the
first person of the
singular (my images, your images). Neural patterns, on the other

hand, can only be known from the third person singular
perspective. If I had the opportunity to see my own neural patterns
with the help of the latest technology, I would still see them from the
third person singular perspective.
Images are not just visual
With the term images I mean mental patterns with a composite

structure based on the features of each sensory modality: visual,
auditory, olfactory, gustatory and somatosensory. The somatosensory
modality (the word comes from the Greek soma, which means body)
comprises various ways of feeling: touch, muscles, temperature,
pain, internal and vestibular organs. The word image does not refer
only to "visual" images, nor is it about static images. The word also
refers to auditory images such as those caused by music and the
wind and to somatosensory images that Einstein used in solving his
mental problems: in his introspective explanation he called them
"muscular" images.1 Images of all modalities they 'represent'
processes and entities of all kinds, both concrete and abstract. The
images also "represent" the physical properties of the entities and
the spatial and temporal relationships (sometimes sketched,
sometimes not) between the entities, as well as their respective
actions. In short, the process we know as the mind when mental
images become ours as a result of consciousness is a continuous
stream of images, many of which happen to be logically related to
each other. The flow moves forward in time, quickly or slowly, orderly
or in leaps, and sometimes moves not in a single sequence but in
several. Sometimes the sequences are
concurrent, sometimes divergent or convergent, sometimes

overlapping. Thought is an acceptable word to designate that flow of
images.
Construction of images
Images are well constructed when we relate to objects, be they

people, places, or toothaches, from outside the brain to inside; well
when we reconstruct objects from memory, so to speak, from the
inside out. While we are awake this image making does not stop and
even continues during part of our sleep, when we dream.
It could be said that images are the currency of our mind.

The words I am using to convey these ideas to you are first formed,
however briefly and schematically, as images of auditory, visual, or
somatosensory phonemes and morphemes before I can bring them
to the page in their written version. In the same way, these written
words that you now have printed before your eyes are first processed
by you as verbal images before they promote the activation of other
images, in this case non-verbal, with which the "concepts" can be
displayed mentally. » which correspond to my words. From this point
of view, any symbol you can think of is an image, and there may be
little mental residue that is not made of images.
Even the sensations that form the background of any mental moment
are images, in the sense expressed above, that is, somatosensory
images that fundamentally serve to signal aspects of the bodily state.
The obsessively repeated sensations that constitute being in the act
of knowing are no exception.
Images can be conscious or unconscious. Keep in mind,

however, that not all the images that the brain builds become
conscious. There are simply too many images being generated and
too much competition to reach that little window in the mind where
images can be made conscious, that is, that window where images
are accompanied by the feeling that we are apprehending them. and
that, as a consequence, we are paying due attention to them. In other
words, metaphorically speaking, there is naturally an underground
under the conscious mind, an underground with many floors. One of
them is made up of images to which we have not paid attention, a
phenomenon to which I have just alluded. Another floor is made up of
the neural patterns and the relationships between neural patterns that
underlie all images, whether they become conscious or not.
Yet another floor has to do with the neural machinery required to

maintain records of neural patterns in memory, that kind of neural
machinery that embodies innate and acquired implicit skills.
representations
The meaning of a few more terms needs to be clarified.

One is representation, a problematic but practically unavoidable
term in discussions of this kind. I use representation either as a
synonym for mental image or as a synonym for neural pattern. My
mental image of a certain face is a representation, as are the neural
patterns that arise during perceptual-motor processing of that face, in
a variety of visual, somatosensory, and motor regions of the brain.
This use of representation is conventional and transparent. It simply
means "pattern consistently related to something," either
with respect to a mental image, or with respect to a coherent set of

neural activities within a specific region of the brain. The difficulty with
the term representation is not its ambiguity, since everyone can guess
what it means, but the implication that, we do not know how, the
mental image or neural pattern represents, in the mind and brain, to
some degree. of fidelity, to the object, as if the structure of the object
were duplicated in the representation. When I use the word
representation I do not make such an allusion. I have no idea how
faithful mental and neural images are in relation to the objects they
refer to. Furthermore, whatever their fidelity, the neural patterns and
corresponding mental images are just as much brain creations as
they are products of the external reality that prompts their creation.
When you and I look at an object that is external to us, we form
comparable images of it in our brains. We know this well because
you and I can describe the object in a very similar way down to the
smallest details. But that does not mean that the image we see is the
copy of whatever the external object is. In absolute terms, what it is
we do not know. The image we see is based on the changes that
occur in our body (including that part of the body called the brain)
when the physical structure of the object interacts with the body.
Signaling devices located throughout the structure of our body (in the
skin, in the muscles, in the retina, and so on) help build neural
patterns that map the interaction of the organism with the object.
Neural patterns are constructed according to the brain's own
conventions and are transiently carried out in multiple sensory and
motor brain regions that are appropriate for processing signals arriving
from particular body locations, such as the skin or muscles. or the
retina. The construction of these neural patterns or maps is based on
the momentary selection of neurons and circuits activated by the
interaction. In others
In other words, the building blocks exist within the brain, available
for use and organization. The part of the pattern that remains in
memory is constructed according to the same principles. Thus, the
images that you and I see in our minds are not facsimiles of a
concrete object but rather images of the interactions between each
of us and the object that activated our organisms, constructed as a
neural pattern according to the design of the organism. . The object
is real, the interactions are real, and the images are as real as you
can imagine. And yet, the structure and properties of the image we
end up seeing are brain constructions triggered by an object. There
is no "photo" of the object that is transferred from the object to the
retina and from the retina to the brain. What there is, rather, is a set
of correspondences between physical characteristics of the object
and reaction modes of the organism according to which an internally
generated image is constructed. And since you and I are biologically
similar enough to construct a similar image of the same thing, we
can easily accept the conventional wisdom that we have formed a
picture of a particular thing. But it has not been that way.
A final reason to be cautious about the term representation is

that it easily evokes the metaphor that the brain is a computer.
Inadequate metaphor, however. The brain does do computations,
but its organization and functioning have little to do with the common
notion of what a computer is.
maps
Many of these nuances apply to the term map, a word that is

almost as unavoidable and compelling as a representation when
discussing the neurobiology of mind. When the particles
of light known as photons hit the retina in a certain way that

corresponds to an object, the nerve cells activated in that way (say a
circle or a cross), constitute a transient neural "map." At other levels
of the nervous system, for example the visual cortices, the consequent
maps related to the previous one are formed.2 Certainly, and as
occurs with the word representation, there is a legitimate notion of
pattern, and of correspondence with what is charted on the map. But
the correspondence is not from point to point, and therefore the map
cannot be faithful. The brain is a creative system. Instead of copying
the environment around it as an information-processing engineering
device would, each brain constructs maps of the environment using
its own parameters and internal design, thus creating a unique world
among similarly designed brains.
Mysteries and knowledge gaps in the making of images
There is no mystery when it comes to the question of where the

images come from. The images come from the activity of the brains
and those brains are part of living organisms that are related to
physical, biological and social environments.
Consequently, the images arise from neural patterns, or neural maps,
made up of populations of nerve cells, or neurons, that constitute
circuits, or networks. However, there is mystery in how images
emerge from neural patterns. Neurobiology has not yet solved the
problem of how a neural pattern becomes an image.
Many of us who work in neuroscience are guided by a single

goal and a single hope: to provide a comprehensive explanation of
how the kind of neural pattern that we can currently describe with the
tools of neurobiology,
from molecules to systems, it ends up becoming the multidimensional

image, integrated in time and space, that we experience at every
moment. The day may come when we can satisfactorily explain all
the steps from the neural pattern to the image, but that day has not
yet come. When I say that images depend on and arise from neural
patterns or neural maps, rather than saying that they are neural
patterns or maps, I am not slipping into an inadvertent dualism, that
is, into a neural pattern on the one hand and a neural pattern on the
other. immaterial cogitum for another. I am simply saying that we
cannot yet characterize all the biological phenomena between: a) our
current description of a neural pattern at various neural levels, and b)
our experience of the image arising from activity within the neural
map. There is a gap between our knowledge of neural events at the
molecular, cellular, and systems levels, on the one hand, and the
mental image whose mechanisms of emergence we wish to
understand. There is a void to be filled with as yet unidentified but
presumably identifiable physical phenomena. The size of that gap
and the degree to which it can be more or less bridged in the future
is naturally a matter of debate. Be that as it may, I want to make it
clear that I consider neural patterns to be the ancestors of those
biological entities that I call images.
The emptiness I have just described is one of the reasons why,

throughout this book, I have maintained two types of description, one
for the mind and one for the brain. This separation is a simple matter
of intellectual hygiene and, once again, it is not the result of dualism.
By maintaining separate types of description I am not suggesting that
there are different substances, one mental and one biological. All I
am doing is acknowledging mind as a high-level biological process,
demanding and deserving of its own description because of the
private nature of its manifestation and because that manifestation is
precisely the fundamental reality we wish to explain. By
On the other hand, describing neural events in their own vocabulary

is part of the effort to understand how such events contribute to the
creation of the mind.
new terms
Some new terms have been introduced in this book, for example,
central consciousness, extended consciousness (first defined in
Chapter 1), and protoser and second-order structure (properly
introduced in Chapters 5 and 6).
Also, my use of the terms emotion and sensation is
unconventional, as I explained at the beginning of Chapter 2, and the
term object is used in a broad and abstract sense: a person, a place,
and a tool are objects, but so are a device. concrete pain and an
emotion.
SOME INDICATIONS ON THE ANATOMY OF THE NERVOUS SYSTEM
The nervous system is made up of nerves or neural tissues. Like

any other tissue, it is made up of cells. Neural cells are known as
neurons, and although they are complemented by other types of cells
(glial cells), everything indicates that neurons are the fundamental
unit, the only essential unit to produce movements and mental activity.
Neurons have three main components: cell body, the complete

powerhouse of the cell with the nucleus and organelles, such as
mitochondria; an output fiber known as an axon and several input
fibers called dendrites. Neurons connect with each other to form
circuits in which we can find the equivalent of conducting wires (the
axons of the neurons) and connections, called synapses (which
generally consist of the contact of an axon with the dendrites of
another neuron) .
There are billions of neurons in the human brain, organized in

localized circuits. These circuits constitute the cortical regions, in
the event that they are organized in parallel layers as in a biscuit, or
the nuclei, in the case of being grouped in non-stratified groups, like
fruits in a bowl. Both cortical regions and nuclei are interconnected
by "projections" of axons to form systems and, at increasing levels
of complexity, systems of systems. When the projections of the
axons are large enough to be seen individually with the naked eye,
they form what are called "pathways." With respect to scale, all
neurons and localized circuits are microscopic, while cortical regions,
most nuclei, and systems are macroscopic.
Figure A.1. The neuron and its main anatomical components.

For purposes of anatomical description, the nervous system is

usually divided into central and peripheral. The main component of
the central nervous system is the cerebrum, which is made up of
the left and right cerebral hemispheres , joined by the corpus
callosum (a thick set of nerve fibers that bidirectionally connect the
right and left hemispheres). The central nervous system also includes
deep nuclei such as a) the basal ganglia, b) the basal forebrain,
and c) the diencephalon (combined thalamus and hypothalamus).
The spinal cord reaches the cerebrum via the brainstem, behind
which is the cerebellum (see figure A.2).
The central nervous system is connected to all points in the body

by nerves, which are bundles of axons that originate in the cell body
of neurons. The set of all the nerves that connect the central nervous
system (the brain, in short) with the periphery and vice versa
constitutes the peripheral nervous system. Nerves carry impulses
from the brain to the body and from the body to the brain. The brain
and body are also chemically connected through substances, such
as hormones, that travel through the bloodstream.
A section of the central nervous system, in any direction you

like, clearly reveals two types of sectors, one light and one dark. The
dark sectors are known as gray matter (although its actual color is
more brown than gray) and the light sectors are known as white
matter (which is not so white either). The gray matter gets its darkest
tint from the great heap of many, many neuron cell bodies. Nerve
fibers, arising from cell bodies located in the gray matter, make up
the white matter. The myelin sheath that insulates nerve fibers gives
white matter its characteristic lighter-colored appearance.
Figure A.2. The major divisions of the central nervous system and their
fundamental components, shown in three-dimensional reconstructions of a living
human brain. The reconstructions are based on BRAINVOX MRI data. Note the
relative positions of the four main lobes, the diencephalon (comprising the
thalamus and hypothalamus), and the brainstem. Also note the position of the
corpus callosum (which joins both hemispheres by its midline) and the cingulate
cortex of each hemisphere. The pattern of gyri and sulci is very similar in the
right and left cerebral hemispheres, but it is not the same: there are significant
asymmetries, and these asymmetries seem to underline functional differences.
Gray matter comes in two forms. Examples of the stratified form

are the cerebral cortices that surround the cerebral hemispheres
and the cerebellar cortex that surrounds the cerebellum. Examples
of the unstratified form, the nuclei, include: the basal ganglia
(situated deep within each of the cerebral hemispheres and composed
of three large nuclei: the caudate, putamen, and pallidum), the
tonsils, a
a single large cluster located deep within each temporal lobe, and
various aggregates of smaller nuclei that form the thalamus ,
hypothalamus , and gray sectors of the brainstem.
The cerebral cortex can be imagined as a blanket that completely

covers the cerebrum, covering the surfaces of the cerebral hemisphere,
including those located deep in the fissures and sulci, those cracks
that give the brain its characteristic wrinkled appearance. The thickness
of this many-layered mantle is about three millimeters, and the layers
are parallel to each other and to the surface of the brain. The modern
part of the cerebral cortex, evolutionarily speaking, is known as the
neocortex. The cerebral cortex is overwhelmingly present and all the
other gray structures, the various nuclei mentioned above, and the
cerebellar cortex are known as subcortical structures.
The main parts of the cerebral cortex are designated according to their
respective lobes: frontal, temporal, parietal, and occipital.
The various regions of the cortical lobes are traditionally identified
by numbers that correspond to the distinctive architecture of their
cellular arrangements (known as cytoarchitecture). The numbering of
the regions emerged with the work of Korbinian Brodmann and is still
a valid tool after almost a century. The numbers have to be learned or
checked against a map and have nothing to do with the size of the
areas or their importance.
When neurons fire (a state known in neuroscientific parlance as

"firing"), an electrical current leaves the cell body and propagates
down the axon. When that current reaches the synapse, it triggers the
release of chemicals known as neurotransmitters (glutamate is an
example of a neurotransmitter). In an excitatory neuron, the joint
interaction of many other neurons with adjacent synapses determines
whether or not the next neuron fires.
that is, whether or not it produces its own action potential, which will
lead to its own release of neurotransmitters, and so on.
Synapses can be strong or weak. Synaptic strength determines

whether or not impulses continue to travel, and how easily, to the
next neuron. In an excitatory neuron, the strong synapse facilitates
the passing impulse, while a weak synapse impedes or blocks it. On
average, each neuron forms about a thousand synapses. Considering
that there are more than ten billion neurons and more than ten trillion
synapses, each neuron tends to converse with a few more but never
with most of the others, much less with all of them. The truth is that
many neurons only converse with neurons not too far away, within
relatively localized circuits within cortical regions and nuclei, while
other neurons, even if their axons extend several centimeters, only
come into contact with each other. with a small number of other
neurons. The action of neurons depends on the close set of neurons
to which they belong; what the systems do depends on how the sets
influence other sets in each architecture of interconnected sets; and
finally, the contribution of each set to the function of the system to
which it belongs depends on its location in said system. The diverse
functions of different brain areas are a consequence of the place
occupied by sets of loosely connected neurons within large-scale
systems. In short, the brain is a system of systems. Each system is
composed of a complex interconnection of subcortical nuclei and
small but macroscopic cortical regions, which are composed of
microscopic localized circuits, themselves made up of neurons, all of
which are connected by synapses.
Figure A.3. Gray matter in the cerebral cortices and deep nuclei.
As indicated in the text, gray matter is made up of tightly packed neuron cell
bodies. The white matter that contrasts with it comprises the axons that originate
in the cell bodies and extend to other regions in order to establish connections
and transmit signals. These sections provide the relative locations of various
structures not visible deep to the surface of the brain: basal ganglia, basal
forebrain, amygdala, thalamus, and hypothalamus. Note also the location of the
insula, a region of the cortex that is part of the somatosensory system and that
is completely hidden in the depths of the sylvian fissure.
Figure A.4. The main anatomical regions of the cerebral hemispheres: the frontal,
temporal, parietal and occipital lobes; Broca's (B) and Wernicke's (W) areas; the
motor (M) and somatosensory (S) areas. Although Broca's and Wernicke's areas
are the best known brain regions in relation to language, there are also other areas
involved in language processing. The same can be said for the motor (M) and
somatosensory (S) regions, which are just the tip of the motor and somatosensory
icebergs. In other parts of the cerebral cortex and below it are many cortical
regions and nuclei that support motor functions (the cingulate cortices, the basal
ganglia, the thalamus, the brainstem nuclei). The same goes for somatosensory
function (brainstem nuclei, thalamus, insula, cingulate cortex).
Figure A.5. The main areas of Brodmann. Numbers do not reflect

functions, importance, or location of these areas. They are nothing more than
a referral code.
THE BRAIN SYSTEMS UNDERLYING THE MIND
For my goal of investigating the relationship between mental

imagery and the brain, I have long used a framework suggested by
the results of experimental and clinical neuropsychology,
neuroanatomy, and neurophysiology. That framework postulates a
space of images and a space of availability. The image space is
one in which images of all sensory types are explicitly given. Some of
these images constitute the manifest mental content that
consciousness allows us to experience while some other images
remain unconscious. The space of availability is the one in which
the dispositions contain the knowledge base and the mechanisms
with which images can be constructed from memory, with which
movements can be originated and with which
facilitate image processing. Unlike the contents of the image space,

which are explicit, the contents of the availability space are implicit.
We can know the contents of images (once the central consciousness
is activated), but we never directly know the available contents.
The available contents are always unconscious and exist in a latent

form. However, these provisions can give rise to a wide variety of
actions: release of hormones into the bloodstream, contraction of
muscles of organs or of a limb or of the vocal apparatus. These
dispositions maintain certain records of the image actually perceived
on some previous occasion and participate in the attempt to
reconstruct a similar image from memory. The arrangements also
help in the processing of an image actually perceived by influencing,
for example, the degree of attention devoted to that image. We are
never aware of the knowledge required to execute all these tasks,
nor are we ever aware of the intermediate steps that are taken. We
are only aware of the results, for example of a state of well-being, of
the acceleration of the heart, of the movement of a hand, of the
fragment of a remembered sound, of the refined version of the
perception of a landscape in the present moment.
All of our memory, inherited by evolution and available at birth or

acquired through later learning, in short, all of our memory of things,
of the properties of things, of people and places, of events and
relationships, of abilities, of biological regulations, of whatever you
want, exist in available form (synonymous with implicit, hidden, not
conscious), waiting to become an explicit image or action. Note that
the provisions are not words. They are abstract registers of
potentialities. They also exist as dispositions to become images and
actions, as in speech and song, words or signs, which
they can come to mean any entity, event, or relationship.

When I think of dispositions I always imagine the people of Brigadoon
waiting to come back to life for a short time.*
We are beginning to discern which parts of the central nervous
system support the image space and which parts support the
availability space. The areas of the cerebral cortex located at the
point of arrival (or in their environment) of the visual, auditory and
other sensory signals (the so-called early sensory cortices of the
different sensory modalities) support explicit neural patterns, as do
some parts of limbic areas, such as the cingulum, and some non-
cortical structures, such as the tectum. These neural map patterns
continually change under the influence of internal and external input
and are probably the basis of images, whose mercurial dynamics
parallel changes in neural patterns over time.
On the other hand, the higher-order cortices (which make up

that ocean of cerebral cortex around the islands of the early sensory
cortices and the motor cortices), certain parts of the limbic cortices,
and numerous subcortical nuclei, from the amygdala to the brainstem ,
harbor dispositions, that is, implicit records of knowledge. (See figure
A.6.) When the circuits in the dispositions are activated, they send
signals to other circuits and cause images or actions to be generated
in other parts of the brain.
This schematic outline also requires the mention of other brain

regions whose ostensible role is the interrelation of signals between
brain areas, together with the control of their occurrence in certain
brain areas. Among those regions are the thalamus, basal ganglia,
hippocampus, and cerebellum.
We would need a textbook to begin to examine the complexity of their
respective works, despite the depth of our ignorance. However, just
to advance some of such an examination, I will limit myself to saying
that the functions of the thalamus, for
For example, the interrelation of signals, the control of brain activities

in different areas and the sending of signals, are essential for
consciousness. However, when it comes to consciousness, the role
of the others is either unclear (basal ganglia, cerebellum) or negligible
(hippocampus).
My proposal is that the arrangements are housed in sets of
neurons called convergence zones. To the partition of space of
images and space of availability corresponds then a partition: 1) in
the explicit maps of neural patterns, activated in the early sensory
cortices, in the so-called limbic cortices and in some subcortical
nuclei and 2) in the areas of convergence, located in the higher order
cortices and in some subcortical nuclei.
It is not clear how this anatomical organization works as a basis

for the kind of integrated and unified images that we experience in
our minds, although some proposals have suggested solutions to
some aspects of this question. This issue is generally known as the
"linkage" problem. Relative to the overall mental picture, the linkage
probably requires some form of temporary blockade of neural
activities occurring in distinct but interconnected brain regions. There
is little doubt that the unified, integrated scene that characterizes the
conscious mind requires enormous signaling, both locally and
globally, from populations of neurons in multiple brain regions.
Figure A.6. a Major early sensory cortices (somatosensory, auditory, and

visual). The term "early" refers not to their evolutionary age but to the order of
entry of the signals in the cerebral cortex. For example, light activates neurons
in the retinas, then in the nuclei of the geniculum, and then in areas 17, 18,
and 19, collectively known as the "early visual cortex." Area 17 is also known
as the "primary visual cortex" or V1.
Areas 18 and 19 are also known as the "visual association cortex" and
comprise subregions known as V2, V3, V4 , and V5. That same general provision
applies to the auditory and somatosensory cortices, respectively, of the temporal
and parietal lobes. b Superior and limbic cortices, partly shaded. The remaining
cerebral cortex is composed of higher order cortices that widely surround the
early cortices and the so-called limbic cortices, ie the cingulate cortices.
Gerald Edelman's notion of reentry addresses this requirement.

Rodolfo Llinás' transcortical "binding wave" and my concept of
retroactivation with time block are other attempts to grasp the
mechanism capable of uniting in space and time the activity of our
brain, which is necessarily fragmented.3 The work of Wolf Singer has
addressed the mechanisms required to generate coherence at the
microstructural level4 and Francis Crick has extensively theorized
about such requirements at the cellular and microcircuit levels.5 Both
Jean-Pierre Changeux and Gerald Edelman have proposed selective
frameworks for the operation of such mechanisms, and the Michael
Merzenich's work shows that the brain has the flexibility to function
in this way.6
Grades
1. Consciousness has been an important philosophical topic although until recently

only a few neuroscientists have addressed it. Neuroscience devoted considerable
attention to the study of consciousness for a brief period in the mid-20th century,
especially in the 1940s and 1950s. The experimental works of G. Magoun, HW
Moruzzi and H. Jasper, as well as the clinical and experimental observations of W.
Penfield stand out among several contributions of the time that ended before their
time. Benjamin Libet is another exception, he is another pioneer. What is known
today as the field of consciousness studies originated independently, inadvertently,
and unexpectedly in the past decade by a handful of philosophers and scientists.
Special thanks are due to philosophers Daniel Denett, Paul and Patricia Churchland,
Thomas Nagel, Colin McGinn, and John Searle, as well as neuroscientists Gerald
Edelman and Francis Crick.
2. I have outlined the problem in Chapter 10, "The Body-Minded Brain," of

Descartes' Error: Emotion, Reason, and the Human Brain (New York: Putnam,
1994; Avon Hearst, 1995). There is a Spanish edition: Descartes' error, Editorial
Destino, 2011.
3. For a pertinent update see J. Levine, "Materialism and qualia: The explanatory
gap," Pacific Philosophical Quarterly 64: 354-361.
4. See Daniel Dennett's book Consciousness Explained (Boston: Little, Brown,

1991) for a full discussion of homuncular explanations for the sense of being.
5. The inability to distinguish the two problems of consciousness outlined in these

pages leads to misleading situations. For example, I interpret the remarkable efforts
of the mathematical physicist Roger Penrose as relevant to clarifying the physical
basis of the qualia problem, although they are invariably described as relevant to
consciousness as a whole. The same can be said for the work of physicist Henry
Stapp. None of them fix their attention on the part of the problem of consciousness
that I am emphasizing in this book, but rather on the more general, and certainly no
less important, problem of the biological basis of mental processes. See R. Penrose,
The Shadows of the Mind (New York: Oxford University Press, 1994). Spanish
edition: Shadows of the mind, Editorial Crítica, 2012; and H. Stapp, Mind, Matter
and Quantum Mechanics (Berlin: Springer Verlag, 1993).
6. Given the enormity of the challenge it would not be surprising if in attempting to

tackle the issue of consciousness, philosophers and neurobiologists alike ran into
numerous barriers and were unable to discover a global solution at an early date.
For example, the word conscience, polygamously paired with too many meanings,
has often stood in the way of an agreement to define the problem; the private nature
of the phenomenon has dissuaded many from even addressing the issue while
convincing others that it could be addressed merely externally, privacy be damned;
the notion that somehow consciousness is at the very peak of human capabilities
has not infrequently given rise to paralyzing fear and the belief that consciousness
is beyond our scientific grasp; the impatience and the desire to tackle and save the
aforementioned impediments has led some to the conclusion that not only can the
conscience be approached but that it is already perfectly clarified; finally, there are
those who think that the problem does not exist at all or that it is the same as the
problem of the mind: the consciousness may or may not be cleared depending on
whether or not the problem of the mind is solved. On this panorama, my position is
that the problem of consciousness exists and that it has not yet been resolved; that
can be cut into parts; that a consensus can be reached regarding those parts and
that, despite its intimate nature, consciousness can be approached scientifically.
7. The term mind, as I use it in this book, encompasses both conscious and
nonconscious operations. It refers to a process, not a thing. What we know as
mind, with the help of consciousness, is a continuous flow of thought patterns,
many of which happen to be logically interrelated. The flow advances in time, quickly
or slowly, orderly or in jumps, and sometimes it does not move through a single
sequence but through several. Sometimes the sequences are concurrent, sometimes
they converge and diverge, sometimes they overlap.
The term I often use as shorthand for mental patterns is images. As already
indicated, images are mental patterns of any sensory modality, not just visual ones.
There are sound images, or tactile images and so on.
8. There is no unanimity in the way of seeing the relationship between mind and
brain, especially with regard to consciousness. It is not possible to cite all the
authors who have recently published important texts on this general subject, but I
recommend a number of books or collections by philosophers of mind who have
given careful attention to these problems. His views and mine do not always agree,
but I have enjoyed reading all of the following: John Searle, The Rediscovery of
the Mind (Cambridge, Mass.: MIT Press, 1992). Spanish edition: The discovery
of the mind, Editorial Crítica, 1996; Patricia and Paul Churchland, On the Contrary
(Cambridge, Mass.: MIT Press, 1998); David J. Chalmers, The Conscious Mind
(New York: Oxford University Press, 1996). Spanish edition: The conscious mind:
in search of a fundamental theory, Editorial Gedisa, SA, 2013; Daniel Dennett,
Consciousness Explained (cited above); Thomas Nagel, The View from Nowhere
(New York: Oxford University Press, 1986); Colin McGinn, The Problem of
Consciousness (Oxford: Basil Blackwell, 1991); Owen Flanagan, Consciousness
Reconsidered (Cambridge, Mass.: MIT Press, 1992); Ned Block, Owen Flanagan,
Güven Güzeldere, eds., The Nature of Consciousness: Philosophical Debates
(Cambridge, Mass.: MIT Press, 1997); Thomas Metzinger, ed., Conscious
Experience (Paderborn, Germany: Imprint Academic/Schöningh, 1995); Fernando
Gil, Modes of Evidence (Lisbon: National Press, 1998); Jerry A.
Fodor, The Modularity of Mind (Cambridge, Mass.: MIT Press, 1983).

9. H. Damasio and A. Damasio, Lesion Analysis in Neuropsychology (New York:

Oxford University Press, 1989).
10. The separation of consciousness into at least two levels of phenomena is well
supported by cognitive and behavioral analyzes and validated by the neurological
observations I present here. The separation is indispensable when it comes to
proposing biological mechanisms capable of producing consciousness. It is unlikely
that there is any single mechanism capable of producing the expanded
consciousness and the central consciousness at the same time. The problem has
also been identified in another biological explanation of consciousness, that of
Gerald Edelman. The dichotomy he proposes also separates the 'simple' from the
'complex', although his categories do not correspond to mine. Gerald Edelman
divides consciousness into primary consciousness and higher-order consciousness,
but his primary consciousness is simpler than my central consciousness and does
not end up producing the emergence of a being. Edelman's higher consciousness
is also not the same as my expanded consciousness because it requires language
and is strictly human.
There have been other authors who propose dichotomous classifications of
consciousness. For example, Ned Block divides consciousness into access
consciousness or A consciousness, and phenomenal consciousness or F
consciousness. [In the original it appears as P consciousness, due to the initial
letter of the word phenomenon in English, phenomenon. (N. of the T.)] Neither of
these concepts is related to the notions of central and extended consciousness.
See Gerald Edelman, The Remembered Present (New York: Basic Books, 1989);
Ned Block et al., The Nature of Consciousness (cited above).
11. A consensus has recently been developing that subjectivity is the "hard problem"
of consciousness, although discussions of subjectivity do not normally require that
there is a subject (a sense of being) and that the means by which we have sense
of being, whether illusory or not, must be an important aspect in clarifying
consciousness. The term "strong problem" was introduced to a wide audience by
David Chalmers in The Conscious Mind (cited above) and is the most recent name
for the old qualia problem. For an earlier statement of the problem, see J.
Levine, "Materialism and qualia" (cited above). For a recent discussion of this
problem see John Searle, The Mystery of Consciousness (New York: New York
Review of Books, 1997). Spanish edition: The mystery of consciousness,
Ediciones Paidós, 2000.
12. For an explanation of how the visual system achieves these representations of
objects, see David Hubel, Eye, Brain, and Vision (New York: Scientific American
Library, 1988). Spanish edition: Eye, brain and vision, University of Murcia,
Publications Service, 2000; and Semir Zeki, A Vision of the Brain (Oxford:
Blackwell Scientific Publications, 1993). Spanish edition: A vision of the brain,
Editorial Ariel, 1995.
13. B. Spinoza, Ethics , P art IV, P roposition 2 2 (In dia n a p olis: H ackett P u blis
hing C o., Inc., 1 9 8 2, first edition in 1 6 7 7 ).
1. Ludwig von Bertalanffy, Modern Theories of Development: An Introduction

to Theoretical Biology (New York: Harper, 1962, first published in German in
1933); P. Weiss, "Cellular dynamics," Review of Modern Physics 31 (1919):
11-20; Kurt Goldstein, The Organism (New York: Zone Books, 1995, first published
in German in 1934).
2. See Gerald Edelman, The Remembered Present, and Antonio Damasio,

Descartes' Error (cited above). Other notable exceptions: Theodore Bullock is the
author of a biology text written from an evolutionary perspective, Introduction to
Nervous Systems (San Francisco: WH Freeman, 1977); Paul MacLean has
discussed a triune brain, with each of its floors belonging to a different evolutionary
epoch, in "The Triune Brain, Emotion, and Scientific Bias," in The Neurosciences:
The Second Study Program, ed. F.O.
Schmitt (New York: Rockefeller University Press, 1970); and Patricia Churchland
founded neurophilosophy by recalling the value of considering evolution in
Neurophilosophy: Toward a Unified Science of the Mind Brain (Cambridge,
Mass.: MIT Press, Bradford Books, 1986).
3. Some of the examples of this change can be found in the work of Jean-Didier
Vincent and Alain Prochiantz in France; by Joseph LeDoux, Michael Davis, James
McGaugh, Jerome Kagan, Richard Davidson, Jaak Panksepp, Ralph Adolphs and
Antoine Bechara in the United States; and Raymond Dolan, Jeffrey Gray and ET
Rolls in Britain, to name only the most conspicuous.
4. A. Damasio, Descartes' Error (cited above); A. Damasio, «The somatic marker

hypothesis and the possible functions of the prefrontal cortex», Philosophical
Transactions of the Royal Society of London, Series B (Biological Sciences)
351 (1996): 1413-1420; A. Bechara, A. Damasio, and S. Anderson, "Insensitivity to
future consequences following damaging to human prefrontal cortex," Cognition
50 (1994): 7-15; A. Bechara, D. Tranel, H. Damasio and A.
Damasio, "Failure to respond autonomically to anticipated future outcomes following
damage to prefrontal cortex," Cerebral Cortex 6 (1996): 215-225; A.
Bechara, H. Damasio, D. Tranel, and A. Damasio, "Deciding advantageously before
knowing the advantegeous strategy," Science 275 (1997): 1293-1295.
5. For the discussion of the cognition of rationality see NS Sutherland, Irrationality:

The Enemy Within (London: Constable, 1992). Spanish edition: Irrationality: the
inner enemy, Alianza Editorial, 2015; for its cognitive and biological aspects, see
Patricia Churchland, "Feeling Reasons," in Paul M. Churchland and Patricia S.
Churchland, On the Contrary (cited above).
6. Other languages that have expressed the heritage of Western philosophy and
psychology have long had the equivalent for the different words that in English
indicate emotion and feeling. For example, the Latin exmove and feel ; the French
émotion and sentiment; the German Emotionen and Gefühl; the Portuguese
emoçâo and sentimento; the Italian emozione and sentimento and so on.
Probably the two words were coined in those languages due to many keen observers
who considered two distinguishable sets of phenomena, noted their separation, and
saw the value of calling them different terms. Referring to the entire process with a
single word, emotion, which is common practice today, is sheer laziness. Nor
should it be forgotten that, in its most general sense, the meaning of the word
feeling [remember that, depending on the context, the word can be translated as
sensation or feeling, indistinctly: in Spanish "we feel a sensation" or "we feel a
feeling"; Despite the fact that Spanish is sometimes forced a bit, I have systematically
translated feeling by sensation, according to the meaning that the author gives to
the text. (N. del T.)] rather denotes a perception related to the body (feelings of
discomfort or well-being, sensations of pain, sensation of touch) than an appreciation
of what is seen or heard. The wise coiners of the word feeling were probably under
the impression, correctly, that feeling an emotion had a lot to do with the body, and
in that they were right on the mark.
7. D. Tranel and A. Damasio, "The covert learning of affective valence does not
require structures in hippocampal system or amygdala," Journal of Cognitive
Neuroscience 5 (1993): 79-88.
8. There is also evidence from studies in healthy individuals without brain damage
that certain preferences can be learned unconsciously and rapidly. See P. Lewicki,
T. Hill, and M. Czyzewska, "Nonconscious acquisition of information," American
Psychologist 47 (1992): 796-801, for a specific experiment. In connection with this
area of study, see J. Kihlstrom, "The cognitive unconscious," Science 237 (1987):
285-294; Arthur S. Reber, Implicit Learning and Tacit Knowledge: An Essay on
the Cognitive Unconscious (New York: Oxford University Press, 1993).
9. Deciding whether something is an emotion or not is not an easy task, and once
the whole range of possible phenomena has been traced, one has to ask whether
a fairly sensible definition of emotion can be formulated, as well as whether a single
term is still valid. useful for describing all those states. There have been others who
have faced the same problem and have come to the conclusion that there is nothing
to do. See Leslie Brothers, Friday's Footprint: How Society Shapes the Human
Mind (New York: Oxford University Press, 1997), and Paul Griffiths, What Emotions
Really Are: The Problem of Psychological Categories (Chicago: University of
Chicago Press, 1997). At this point, however, my preferences are directed towards
retaining the traditional nomenclature, clarifying the use of terms and waiting for
new evidence to dictate a new classification in the hope that by maintaining some
continuity we will facilitate communication in this state of uncertainty. transition. I
will talk about three degrees of emotion: background, primary and secondary. That's
revolutionary enough for today, since background emotions aren't part of the usual
list of emotions.
I will speak of impulses, motivations, pain and pleasure as triggers or constituents
of emotions, but not as emotions in the proper sense. Undoubtedly, all these
devices have the purpose of regulating life, but it is debatable that emotions are
more complex than drives and motivations, than pain and pleasure.
10. Emotions have varied temporal profiles. Some emotions tend to set off in an
"explosive" pattern. They go through a relatively quick onset, a peak in intensity,
and a quick decay. Examples of this are anger, fear, surprise and disgust. Other
emotions follow a more 'rippling' pattern: prominent examples are sadness and all
background emotions. It should be made clear that many variations of the profile
are possible depending on the circumstances of the individuals.
When emotional states tend to be quite frequent or even continuous over long
periods of time, it is preferable to refer to them as moods and not as emotions. I
think moods should be distinguished from background emotions; a particular
background emotion can be sustained for a period of time to give a mood. If people
think of us as "taciturn" it is because, consequently, we have been emitting a
predominant emotional note over the others (perhaps related to sadness or anxiety)
most of the time or that perhaps we have changed our emotional melody. frequently
and unexpectedly. Fifty years ago we would have been called "neurotics" in such a
case, but now nobody is neurotic anymore.
Moods can be pathological and thus we speak of mood disorders. Common

examples are depression and mania. We are depressed when the emotion of
sadness lasts for days, weeks and months, when melancholy thoughts, crying and
loss of appetite, sleep and energy are not a single outburst or a smooth coming and
going but a way of being continued, both physical and mental. The same applies to
mania. It is one thing to jump for joy at an event that deserves it or to be enthusiastic
about our vital projects and another thing is to maintain joy and exuberance day
after day, justified or not. For apt descriptions of the experience of mood disorders,
see Kay Redfield Jamieson, An Unquiet Mind (New York: Knopf, 1995); William
Styron, Darkness Visible: A Memoir of Madness (New York: Random House,
1990). Spanish edition: That visible darkness, Grijalbo-Mondadori, 1996; and
Stuart Sutherland, Breakdown: A Personal Crisis and a Medical Dilemma,
updated edition (London: Wiedenfeld and Nicolson, 1987). See Robert Robinson
for medical information on mood disorders.
Because moods are sustained emotions along with their corresponding

feelings, moods carry over time the collection of responses that characterize
emotions: endocrine changes, changes in the autonomic nervous system,
musculoskeletal changes, and changes in the way to process images. When this
package of reactions is persistently and inappropriately exhibited over prolonged
periods of time, the cost to the affected individual is prohibitive. The term condition
is often used as a synonym for "mood" or "emotion", although it is more general
and can designate the whole of the
subject we are discussing here: emotions, moods, feelings. Affection is what we

exhibit (manifest) or experience (feel) towards an object or a situation every day of
our lives, whether we are melancholy or not.
11. The substantial differences between "background" emotions and "conventional"

emotions lie in: 1) the source of the immediate inducer, which is generally external
or represents the exterior in the case of background emotions; and 2) the focus of
responses, whose targets prefer the musculoskeletal and visceral systems in
"conventional" emotions but prefer the internal milieu in "background" emotions. All
the evolution of emotions must have started with background emotions. When we
compare background emotions with the "big six" and with the so-called "social"
emotions, we notice an increasing degree of specificity in inducers, responses, and
response targets, as well as a progressive differentiation of controls, moving from
general controls to localized controls.
12. P. Ekman, "Facial expressions of emotions: New findings, new questions,"

Psychological Science 3 (1992): 34-38.
13. The terms "social" and "secondary" should not imply that these emotions only
originate through education within a culture. In an interesting essay on emotions,
Paul Griffiths (What Emotions Really Are, cited above) rightly points out that
secondary emotions are not just a result of culture; which made me realize that I
had not emphasized this idea enough in Descartes' Error. Without a doubt, the
role society plays in shaping secondary emotions is greater than in the case of
primary emotions. Moreover, it is clear that there are some "secondary" emotions
that begin to appear late in human development, surely only after a certain self-
concept matures (shame and guilt are examples of this late development); newborns
have no shame or guilt, but they do when they are two years old. However, that
does not mean that secondary emotions are not biologically predetermined, partially
or totally.
14. R. Bandler and MT Shipley, «Columnar organization in the midbrain

periaqueductal gray: Modules for emotional expression?», Trends in Neurosciences
17 (1994): 379-389; MM Behbehani, "Functional characteristics of the midbrain
periaqueductal gray," Progress in Neurobiology 46 (1995): 575-605; JF Bernard
and R. Bandler, «Parallel circuits for emotional coping behaviour: New pieces in the
puzzle», Journal of Comparative Neurology 401 (1998): 429-446.
15. A. Damasio, T. Grabowski, H. Damasio, A. Bechara, LL Ponto, and R. Hichwa,

"Neural correlates of the experience of emotion," Society for Neuroscience
Abstracts 24 (1998): 258. Our discovery of the Brainstem activation in negative
emotions is recent, as is the discovery of hypothalamic activation in sadness. Our
discovery of ventral medial prefrontal cortex activation confirms earlier findings by
ME Raichle, JV Pardo, and PJ Pardo; from EM Reiman, R. Lane et al; and Helen
Mayberg.
16. See Joseph LeDoux, The Emotional Brain: The Mysterious Underpinnings
of Emotional Life (New York: Simon and Schuster, 1996). Spanish edition: The
emotional brain, Editorial Planeta, SA, 2000, for a review of animal research on
the subject of fear.
17. M. Mishkin, "Memory in monkeys severely impaired by combined but not

separate removal of amygdala and hippocampus," Nature 273 (1978): 297-298;
Larry Squire, Memory and Brain (New York: Oxford University Press, 1987); F.K.
D. Nahm, H. Damasio, D. Tranel, and A. Damasio: "Crossmodal associations and
the human amygdala," Neuropsychologia 31 (1993): 727-744; Leslie Brothers,
Friday's Footprint (cited above).
18. A. Bechara, D. Tranel, H. Damasio, R. Adolphs, C. Rockland, and AR Damasio,

"A double dissociation of conditioning and declarative knowledge relative to the
amygdala and hippocampus in humans," Science 269 (1995): 1115-1118.
19. R. Adolphs, D. Tranel, and AR Damasio, "Impaired recognition of emotion in

facial expressions following bilateral damage to the human amygdala," Nature 372
(1994): 669-672. R. Adolphs, H. Damasio, D. Tranel, and AR Damasio, "Cortical
systems for the recognition of emotion in facial expressions," Journal of
Neuroscience 16 (1996): 7678-7687.
20. R. A d olphsy AR Damasio, "Thehumanamygdala in social judgement," Nature

393 (1998): 470-474.
21. Interestingly, when the brain mechanisms underlying emotion are impaired, the
ability to attribute emotion to the single cursor is also impaired. This is what Andrea
Heberlein and Ralph Adolphs have just demonstrated in our laboratory. Patients
with lesions in specific places of induction of emotions, describe the shapes and
movements of the cursors in a precise way and without beating around the bush.
However, they fail to spontaneously assign emotions to cursors or their
interrelationships. The manifest intellectual level of the demonstration is perceived
without error, but the emotional context that underlies it is not detected. AS
Heberlein, R. Adolphs, D. Tranel, D. Kemmerer, S. Anderson, and A. Damasio,
"Impaired attribution of social meanings to abstract dynamic visual patterns following
damage to the amygdala," Society for Neuroscience Abstracts 24 (1998): 1176.
22. Eric R. Kandel, Jerome Schwartz, and Thomas M. Jessell, eds., Principles of
Neural Science, 3rd ed. (Norwalk, Conn.: Appleton and Lange, 1991).
23. I have previously described this episode in Descartes's Error and will briefly
summarize it here.
24. P. Rainville, GH Duncan, DD Price, B. Carrier, and MC Bushnell, "Pain affect

encoded in human anterior cingulate but not somatosensory cortex," Science 277
(1997): 968-971; P. Rainville, RK Hofbauer, T. Paus, GH Duncan, MC Bushnell,
and DD Price, "Cerebral mechanisms of hypnotic induction and suggestion,"
Journal of Cognitive Neuroscience 11 (1999): 110-125; P. Rainville, B. Carrier,
RK Hofbauer, MC Bushnell, and GH Duncan, "Dissociation of pain sensory and
affective dimensions using hypnotic modulation," Pain (in press).
25. See AK Johnson and RL Thunhorst, "The neuroendocrinology of thirst and salt
appetite: Visceral sensory signals and mechanisms of central integration," Frontiers
in Neuroendocrinology 18 (1997): 292-353, for a review of the complex
mechanisms involved in behaviors like thirst
1. John Searle has presented a lucid defense of this position in The Discovery of
Mind (cited above). Similar arguments have been made by Daniel Dennett in
Conciousness Explained (cited above).
2. Descriptions of coma and vegetative state are presented in Chapter 8 and are
well covered in neurology textbooks. A standard reference is the text by Fred Plum
and Jerome B. Posner, a classic in which they review their unique expertise in the
neurology of coma. See F. Plum and JB
Posner, The Diagnosis of Stupor and Coma, 3rd ed. (Philadelphia: F.A. Davis
Company, 1980).
3. Jean-Dominique Bauby, Le scaphandre et le papillon (Paris: Editions Robert

Laffont, 1997). Spanish edition: The Diving Bell and the Butterfly, Plaza & Janés
Editores, SA, 1998; J. Mozersky, Locked In: A Young Woman's Battle with
Stroke (Toronto: The Golden Dog Press, 1996).
4. Descriptions of status epilepticus and akinetic mutism are standard descriptions

and can be found in numerous neurology articles and textbooks. Accessible
references include the following: Wilder Penfield and Herbert Jasper, Epilepsy and
the Functional Anatomy of the Human Brain (Boston: Little, Brown, 1954); J.
Kiffin Penry, R. Porter, and F. Dreifuss, "Simultaneous recording of absence
seizures with video tape and electroencephalography, a study of 374 seizures in 48
patients," Brain 98 (1975): 427-440; F. Plum and JB Posner, The Diagnosis of
Stupor and Coma (cited above) and A. Damasio and GW Van Hoesen, "Emotional
disturbances associated with focal lesions of the limbic frontal lobe," in The
Neuropsychology of Human Emotion: Recent Advances, ed. by Kenneth
Heilman and Paul Satz (New York: The Guilford Press, 1983): 85-110. The
inferences I make about the standard evidence for consciousness are based on my
own observations of patients so affected.
5. Exa min oestae vid en cia in c ap t er 5, inside the forest of the representation
of objects.
6. My comments about epilepsy and emotion are typical of an absence seizure

situation. When automatisms occur in the context of so-called temporal lobe attacks,
emotions may appear before or during the episode. Partial dysfunctions of emotion
are not associated with the abolition of central consciousness. For example, patients
with ventral medial frontal lobe lesions described in Descartes' Error lose only
secondary emotions. They lose their ability to react with shame in social situations
or react with fear to possible financial loss in the distant future, but most of their
background emotions and primary emotions remain in place. Similarly, as we saw
in the examination of Patient S, damage to the amygdala disrupts some primary
and secondary fear-related emotion but not other primary and secondary emotions,
and does not compromise background emotions at all.
1. This is a matter that deserves further attention. I have discovered a few

exceptions to the observation that impaired consciousness is always
accompanied by impaired emotion as well, but it would be important to study
the exceptions systematically. My experience tells me that they are, above
all, outbursts "as if feigned" of anger or laughter, that is, unmotivated
behaviors that seem to indicate the implementation of automated routines,
and occur in a persistent vegetative state or in non-absence attacks
associated with lesions in the temporal lobe.
2. The work of Francis Crick exemplifies this position. Insofar as the full elucidation
of consciousness requires an understanding of the image-making process, Crick's
approach is fruitful: of course one must understand how the brain comes to form
images, and his hypothesis offers several opportunities for testing. But Crick
believes that "there are many forms of consciousness, such as those associated
with seeing, thinking, emotion, pain, and so on" and that "self-awareness (i.e., the
self-referential aspect of consciousness) it is probably a special case of conscience.
From our point of view, it is better to leave it aside for now.
F. Crick, The astonishing Hypothesis: The Scientific Search for the Soul (New
York: Scribner, 1994). Spanish edition: The scientific search for the soul: a
revolutionary hypothesis for the 21st century, Editorial Debate, 2000. My
concern is that the elimination of self-reference may create a barrier to a
comprehensive solution to the problem of consciousness.
3. In an important, seminal critique, Güven Güzeldere lists a few contemporary

"inner sense" philosophers: David Armstrong, Paul Churchland, Daniel Dennett,
David Rosenthal, Peter Carruthers, and William Lycan. See G. Guzeldere, "Is
Consciousness the Perception of What Passes in One's Mind?" in T. Metzinger,
ed., Conscious Experience (cited above, see chapter 1).
4. Consciousness is selective because it does not encompass all objects of the mind.
To put it simply, some objects can be made more conscious than others. In the
jumble of images of objects that could be made conscious, not all of them are. The
truth is that no object is the same as another because there are objects more valuable
than others for an organism concerned with maintaining life.
Consciousness is a continuous property of the mind because in normal, awake

minds things to be known are continually being represented. This is a consequence
of the condition of awake complex organisms: they are either perceptually involved
in the external world or actively engaged in producing internally remembered images,
or, more commonly, both. That the machinery that generates consciousness does it
discreetly instead of doing it continuously is another matter.
I believe that the machinery produces "pulses" of central consciousness, many

singular units of consciousness occurring one after the other from various generators
of consciousness. The interval between units is so small and the number of parallel
pulses so abundant that we are only aware of a blurry continuity, like a buzz.
Consciousness corresponds to objects other than itself. On the one hand there
is an object and on the other hand there is the consciousness of that object, separable
from it but clearly related to it. Consciousness is "distinct" from the objects it deals
with, a fundamental separation that modern explanations of consciousness often
overlook.
Consciousness is personal in the sense that it arises in a given organism and
that it deals with the events that happen to that organism. By "staff"
James also meant that it was internal, unobservable from the outside. The properties
of consciousness that I have outlined above provide a description of the components
of that last and highest property: the personal aspect of consciousness. The
individual perspective helps define the personal nature of Jamesian consciousness.
Individual ownership completes the definition of personal, and so does being a
personal agent.
See William James, The Principles of Psychology, vol. 1 (New York: Dover
Publications, 1950).
5. B. Libet, "Timing of cerebral processes relative to concomitant conscious

experience in man," in Advances in Physiological Sciences, ed. G. Adam, I.
Meszaros and EI Banyai (Elmsford, NY: Pergamon Press, 1981).
6. The neuropsychologist Marc Jeannerod has shown that the process of effective
execution of motor activity masks the mental process that constitutes the preparation
of movements. See M. Jeannerod, "The representing brains: Neural correlates of
motor intention and imagery," Behavioral Brain Sciences 17 (1994): 187-202.
Neurophysiologist Alain Berthoz has studied the physiology of the matter in detail.
See A. Berthoz, Les sens du movement (Paris: Editions Odile Jacob, 1997).
1. Descartes' error, chapter 10 and introduction.

2. Claude Bernard, Introduction à l'étude de la médecine experimentale (Paris: J.

B. Baillière et fils, 1865). Spanish edition: Introduction to the study of
experimental medicine, Crítica, 2005; Walter B. Cannon, The Wisdom of the
Body (New York: W. W. Norton and Co., 1932).
3. Steven Rose, Lifelines: Biology beyond Determinism (New York: Oxford

University Press, 1998).
4. Looking for precedents for this general idea that, in some way, the body is the
ground of being, I have found them in Kant, Nietzsche, Freud and Merleau-Ponty,
although not in the way that I have articulated the idea through this tripartite
organization of proto-self, central consciousness, and autobiographical self, and
also not with my emphasis on homeodynamic stability. Edelman's distinction
between being and non-being is also based on a distinction between body and non-
body, although in his frame of reference being refers to biological individuality and
is not in connection with being aware of my proposal of it. way. The philosophers
Mark Johnson and George Lakoff establish a close connection between cognition
and bodily representation, as does the neurophysiologist Nicholas Humphrey. Israel
Rosenfield also links body and being, but indirectly, through memory, and his sense
of being is biased towards that kind of being that I call autobiographical.
5. F. Nietzsche, in the prologue to Thus Spoke Zarathustra. Some translations

speak of "specter" instead of "ghost" and of "disharmony" instead of "discord."
6. This aspect of biology is surprisingly often overlooked. As exceptions, I

recommend Humberto Maturana and Francisco Varela, two biologists who have
coined a suitable word to describe the reconstructive process of living cells:
autopoiesis. See H. Maturana and F. Varela, The Tree of Knowledge: The
Biological Roots of Human Understanding, ed. rev. (Boston: Shambhala, 1992).
Spanish edition: The Tree of Knowledge, Editorial Debate, 1999. In general, these
notions are replicated in the philosophy of Alfred North Whitehead, Process and
Reality (New York: Free Press, 1969 c. 1929). In a note to the text, Pierre Rainville
drew my attention to the notion of the "neuromatrix" developed by Ronald Melzack
in connection with his studies of pain and phantom limbs. Melzack suggests that we
are born with a genetically controlled, experientially modifiable neural network that
underpins our sense of body. This would explain why so many children born without
limbs experience "ghosts" of arms and hands they never had. It would also help
explain some of the phantom limb phenomena recently studied by VS Ramachandran.
7. For a study of the mechanisms that allow us to make perceptual-motor

adjustments, see the work of Alain Berthoz (cited above).
8. The fact that the "senses" are naturally combined evokes the notion of synesthesia.
Synesthesia is a rare phenomenon. In the few individuals who experience it, it tends
to decrease or disappear after infancy.
It consists of perceiving a stimulus in a certain sensory modality, a sound for
example, and that the stimulus provokes a related experience, for example a color
or a smell. The differentiation between our non-synaesthetic sensory devices often
prevents us from apprehending sensory signals in a mixed way; people who possess
the creative touch of synesthesia directly apprehend this intermingling of the senses.
Synesthetes usually develop coherent links between certain sensations, such as a
musical note and a number. Several brilliant composers and musical prodigies have
been synesthetes, and some 19th- century thinkers had the surprising insight that
synesthesia might be a key to understanding consciousness. I might add that they
weren't far off the trail. Neuropsychologist AR Luria offered a vivid description of
synesthesia in his description of the mnemonic Solomon S., a case dramatized by
Peter Brook and Marie-Hélène Estiènne in their play Je suis un phenomène! and
movingly performed by Brook at the Théatre des Bouffes-du-Nord.
Richard Cytowic has written a valuable study on synesthesia; see The Man Who
Tasted Shapes (New York: Putnam, 1993).
9. A. Craig, "An ascending general homeostatic afferent pathway originating in

lamina I," in Progress in Brain Research 107 (1996): 225-242; Z. Han, E.T.
Zhang and AD Craig, "Nociceptive and thermoceptive lamina I neurons are
anatomically distinct," Nature Neuroscience 1 (1998): 218-225.
10. WD Willis and RE Coggeshall, Sensory Mechanisms of the Spinal Chord,

2nd ed. (New York: Plenum Press, 1991). See also Craig (1996), cited above, for a
careful discussion of the integration of the 'body' senses at different levels of the
nervous system, from the spinal cord to the cerebral cortices.
11. Approaching the problem from a very different perspective, the philosopher
Fernando Gil has advanced the concept of a similar previous non-conscious entity
baptized with the same name. We had never discussed the matter and discovered
the compatibility of our points of view on the same day and in the same place,
listening to each other at our respective conferences.
The term being is widely used in disciplines such as immunology and
psychology, and its meaning varies considerably, although all of these uses share
the notion of a unique individual. The psychological literature contains revealing
examinations of the notion of being, such as Ulric Neisser's examination of the five
beings (although none of them correspond to the levels I describe and although,
unlike mine, they are all based on external information rather than internal
information). In the neurobiological literature, Gerald Edelman's "concept of being"
corresponds to the higher realms of my autobiographical self. See U. Neisser, "Five
kinds of self knowledge," Philosophical Psychology 1 (1988): 35-59; G. Edelman,
The Remembered Past (cited above, see chapter 1).
12. See the discussion of the reticular formation concept in Chapter 8.

13. J. Panksepp, Journal of Consciousness Studies 5 (1998): 566-582. In a

related expansion to this article, in the fall of 1998, Douglas Watt posted an article
on the Internet linking emotion to consciousness.
Efforts like those of Panksepp and Watt are rare and welcome.
14. G. Tononi, O. Sporns, and G. Edelman provide a plausible model for the kind
of interactions such a process requires within early sensory cortices; see "Reentry
and the problem of integrating multiple cortical areas: Simulation of dynamic
integration in the visual system," Cerebral Cortex 2 (1992): 310-335. In a recent
article, G. Tononi and G. Edelman substantially extend that model so that it can
encompass large-scale cortical integration; see "Neuroscience: Consciousness and
complexity," Science 282 (1998):1846-1851.
15. A. Damasio, "Time-locked multiregional retroactivation," 1989; A. Damasio,

«The brain binds entities and events», 1989, (cited above).
16. A. Damasio, D. Tranel, and H. Damasio, "Face agnosia and the neural substrates
of memory," Annual Review of Neuroscience 13 (1990): 89-109.
17. D. Tranel, A. Damasio, and H. Damasio, "Intact recognition of facial expression,

gender, and age in patients with impaired recognition of face identity," Neurology,
38 (1988): 690-696.
18. A. Damasio, H. Damasio, and G. Van Hoesen, "Prosopagnosia: Anatomic basis

and behavioral mechanisms," Neurology 32 (1982): 331-341.
19. N. Kanwisher, J. McDermott, and MM Chun, "The fusiform face area: A module
in human extrastriate cortex specialized for face perception," Journal of
Neuroscience 17 (1997): 4302-4311.
20. DK Meno, AM Owen, EJ Williams, PS Minhas, CMC Allen, SJ

Boniface, JD Pickard, IV Kendall, SPMJ Downer, JC Clark, TA
Carpenter and N. Antoun, "Cortical processing in persistent vegetative state,"
Lancet 352 (1998): 800. This interesting finding should not be taken to mean that
all patients in a persistent vegetative state show such activation patterns. Some
patients will not show them due to the size and distribution of their lesions.
1. An example will further clarify the idea. Let us consider a situation in which a
particular object is in front of an organism and is grasped by vision. Later I will deal
with the situation in which objects become present in memory, although the essence
of the process does not differ from that of memory.
The fundamental events that occur in our organism when we are confronted
with an object are of two main types. In the first place, there are changes in the
state of our organism caused by the adjustments required by the perceptual-motor
process, for example, eye movements, head and body movements, hand
movements, vestibular changes and so on. Second, there are changes caused by
the impact of the object in the state of the internal environment and internal organs.
The latter comprise the type of responses that end up generating emotions and that
begin by changing both the organism and its representation, even before the
specific emotional states occur. It must be remembered here that our previous
experience with specific objects and with the same type of objects practically turns
any object into an inducer of some emotional reaction, weak or strong, good or bad,
or of a type in between. We should also remember that, as I have pointed out
before, emotion has a truly dual status in relation to consciousness: the actual
responses whose consequences, as a whole, end up producing an emotion are part
of the mechanism that drives the central consciousness; however, immediately
afterwards, they can also be treated as objects by knowing the set of responses
that constitute the particular emotion. When the "emotional" object becomes
conscious, it becomes the sensation of the emotion.
From the point of view of the brain, the fundamental events described above
are signaled in the appropriate regions to signal the object and the protoser, as
already discussed. However, the nonverbal account that I propose as an essential
component of consciousness is also based on other brain structures and describes
how the events that I have just enumerated are caused by the sensory representation
that is being manufactured of the presence of the object and the obligatory body's
reaction to it, both mechanically and emotionally. The nonverbal account establishes
the relationship between the object, on the one hand, and the organism, represented
by the protoser, on the other.
It tells a very clear story (a primordial story) and the secret of its argument is that
the organism has been altered by the object.
2. The words "description," "arising from," and "relationship" in these sentences

mean exactly that. By description I mean neurally mapped signals; originated by
and relation apply to the close temporal succession between the occurrence of the
images of the object and the occurrence of the images that accompany it. I do not
mean that the brain is prepared in advance to detect causality. Causality and logical
relationships surely arise naturally from the processes executed by the brain within
a given anatomy. By the same token, the brain does not lack a pre-existing sense
of what "objecthood" is, although the design of the brain's perceptual systems and
the different importance of the various objects that provide well-being to the
organism do help to extract objects. of the jumble of stimuli that affect the body's
somatomotor apparatus.
3. We can ask ourselves if the non-verbal story that I have just described is nothing
more than a fiction and if knowing the self is nothing more than an illusion. This is
an interesting question and has more than one answer, but mine is that they are
not fiction. After all, we do come to verify independently, a posteriori, in ourselves
and in other beings, that the character types of the primordial plot, that is, the
individual living organisms, objects, and relationships portrayed in the plot, are in
reality systematic, coherent and general occurrences. In that sense they are not
invented because they respect a standard of relative truth. On the other hand, it is
difficult to imagine that they represent an absolute truth. On a universal scale, the
achievement of consciousness is modest and what it allows us to see is limited.
4. A. Damasio and H. Damasio, “Cortical systems for retrieval of concrete

knowledge: The convergence zone framework,” in Large-Scale Neuronal Theories
of the Brain, Cristof Koch and Joel L. Davis, eds. (Cambridge, Mass.: MIT Press,
1994): 61-74; A. Damasio, "Concepts in the brain," Mind and Language 4 (1989):
24-28.
5. Jerome Kagan, The Second Year: The Emergence of Self-Awareness

(Cambridge, Mass.: Harvard University Press, 1981), M. Lewis, "Sel-conscious
emotions," American Scientist 83 (1995): 68-78.
6. For more insight into the memory process, see Descartes' Error (Chapter 9)
and Daniel Schacter's Searching for Memory: The Brain, the Mind, and the Past
(New York: Basic Books, 1996). Spanish edition: In search of memory, Ediciones
B, SA, 1999. My idea of memory is based on Frederic Barlett, who put forward the
idea that we do not remember facsimiles of perceived objects but that we
reconstruct, to the best of our ability, a certain approximation to the original
perception. Frederic C. Barlett, Remembering: A Study in Experimental and
Social Psychology (Cambridge, England: The University Press, 1954). Spanish
edition: Remember: study of experimental and social psychology, Alianza
Editorial, SA, 1999.
7. John Ashbery, "Self Portr ait in a Convex Mirror," in Selected Poems (New York:
Penguin, 1986 ).
8. RW Sperry, MS Gazzaniga, and JE Bogen, "Interhemispheric relationships:

The neocortical commisures; syndromes of their disconnection”, in Handbook of
Clinical Neurology, PJ Vinken and GW Bruyn, eds., vol. 4 (Amsterdam: North
Holland, 1969): 273-290.
9. Julian Jaynes, The Origin of Consciousness in the Breakdown of the

Bicameral Mind (Boston: Houghton Mifflin, 1976); D. Dennett, Consciousness
Explained (cited above); H. Maturana and F. Varela, The Tree of Knowledge
(cited above).
10. The verse seems motivated by an unexceptional event: a guard alone at night
asks "Who goes?" hearing footsteps. It is not, however, a mere 'qui vive' , and it
seems unlikely that Shakespeare did not use it deliberately as a means of
announcing the inquisitive depth of his play. Some years ago, Peter Brook exposed
the importance of this inaugural question in a play he wrote and staged, based on
Hamlet , entitled Qui est là?
11. Other authors have commented, directly or indirectly, on the existence of a

narrative disposition in the human mind. Daniel Dennett, in describing his multidraft
model of consciousness, implicitly uses verbal narrative as the basis for what I call
expanded consciousness. Michael Gazzaniga has drawn attention to the language-
fabulating tendencies of the left hemisphere of the human brain in split-brain
patients and has postulated a language-based cortical "interpreter"; and Mark
Turner has suggested that these literary narratives are homologous to higher
cognitive processes. See D. Dennett, Consciousness Explained (cited above); M.
Gazzaniga, The Mind's Past (Berkeley: University of California Press, 1998); and
M. Turner, The Literary Mind (New York: Oxford University Press, 1996).
12. A notion reminiscent of my second-order map is examined by Wolf Singer

(1998) and Gerd Sommerhoff (1996). In both cases the authors see the need to
form meta-representations of ongoing brain activities, but the neural localization of
the representations is quite different from mine in Singer's case (who proposes to
locate them in more recent cortical structures, such as the prefrontal cortices) and
is not specified in Sommerhoff's case. In both cases, the result of the meta-
representations would be a kind of global work space instead of a feeling of being
as I specify. W. Singer, "Consciousness and the structure of neuronal
representations," Philosophical Transactions of the Royal Society of London
series B (Biological Sciences) 353 (1998): 1829-1840; G. Sommerhoff,
"Consciousness Explained as an Internal Integrating System," Journal of Conscious
Studies 3 (1996): 139-157.
1. Jerome Kagan, The Second Year (cited above); M. Lewis, "Self conscious
emotions," 1995 (cited above).
2. See P. Goldman-Rakic, "Circuitry of primate prefrontal cortex and regulation of

behavior by representational memory," in Handbook of Physiology: The Nervous
System, vol. 5, F. Plum and V. Mountcastle, eds. (Bethesda, Md.: American
Physiological Society, 1987): 353-417; A. Baddeley, "Working memory," Science
255 (1992): 566-569; Edward Smith and John Jonides for references on working
memory in general (EE Smith, J. Jonides, and RA Koeppe, "Dissociating verbal and
spatial working memory using PET," Cerebral Cortex 6 [1996]: 11-20; EE Smith ,
J. Jonides, RA Koeppe, E. Awh, EH Schumacher, and S. Minoshima, "Spatial
versus object working-memory: PET investigations," Journal of Cognitive
Neuroscience 7 [1995]: 337-356, and Stanislas Dehaene and JeanPierre Changeux
for the proposed connection between working memory and consciousness (in
Gulbenkian Symposium on Consciousness, 1998).
3. Bernard J. Baars, A Cognitive Theory of Consciousness (New York:

Cambridge University Press, 1988). See also J. Newman, "Putting the puzzle
together, Part II: Towards a general theory of the neural correlates of consciousness,"
Journal of Consciousness Studies 4:2 (1997): 100-121.
4. Hans Kummer, In Quest of the Sacred Baboon: A Scientist's Journey

(Princeton, NJ: Princeton University Press, 1995); Marc D. Hauser, The Evolution
of Communication (Cambridge, Mass.: MIT Press, 1996).
5. A. Damasio, NR Graff-Radford, H. Damasio, "Transient partial amnesia,"

Archives of Neurology 40 (1983): 656-657.
6. J. Babinski, "Contribution à l'étude des troubles mental dans l'hémiplegie

organique cérébrale (anosognosie)", Revue neurologique 27 (1914): 845-847.
7. The forgetfulness that anosognosic patients manifest towards their affected

members is matched by the lack of concern they show for their situation in general.
The news that they have had a severe attack and that they may have serious health
problems from then on are usually received with great equanimity. In contrast, when
bad news of the same nature is given to a patient with left hemisphere mirror image
damage, the reaction is completely normal. In a systematic study of anosognosic
patients, my colleague Steven Anderson has confirmed that anosognosia goes
beyond paralysis and encompasses the patient's entire health situation and its
consequences. Having a faulty autobiography deprived of adequate updating,
patients with anosognosia cannot build an appropriate theory of what is happening
to them, or what may happen to them in the future, or what others may think of
them . They also do not realize that their theory is not correct. When the
autobiographical image of oneself is so threatened, it is no longer possible to realize
that the thoughts and actions of the being are no longer normal. See S. Anderson
and D. Tranel, "Awareness of disease states following cerebral infraction, dementia
and head trauma: Standardized assessment," The Clinical Neuropsychologist 3
(1989): 327-339.
8. One would have to ask why this map is biased towards the right hemisphere
instead of being bilateral, considering that the body has two almost symmetrical
halves. The answer: in humans, as in non-human species, functions seem to be
distributed asymmetrically to the cerebral hemispheres, probably because one
ultimate controller is better than two when it comes to choosing an action or an
idea. (If both sides had the same preference in making a move, we might end up in
a dilemma; the right side would interfere with the left, and we would be less likely to
produce coordinated patterns of movement that would engage more than one limb.)
some functions, the structures of a hemisphere must have some advantage, a
functional arrangement that is called dominance.
The best known example of dominance concerns language. (In more than 95%
of people, including many left-handers, language depends primarily on left
hemisphere structures.) Another example of dominance, this time in favor of the
right hemisphere, involves integrated bodily sensation. As indicated above, it is not
a simple and continuous map but rather a set of maps segregated from each other
and coordinated. The representation of the extrapersonal space or superior level of
representation of the corporal state and the representation of the emotion, both
suppose a dominance of the right hemisphere.
9. Kenneth Heilman has recently added an interesting twist to this traditional view
by suggesting that patients also lack the intention to move and thus lack a means
of easily ascertaining their own defect. KM Heilman, AM Barrett, and JC Adair
"Possible mechanisms of anosognosia: a defect in self-awareness," Philosophical
Transactions of the Royal Society of London series B (Biological Science series)
353 (1998): 1903-1909.
10. A. Damasio, "Time-locked multiregional retroactivation," 1989; A. Damasio,

"The brain binds entities," 1989 (cited above); A. Damasio and H. Damasio, "Cortical
systems for retrieval of concrete knowledge" in Large-Scale Neuronal Theories of
the Brain (cited above).
11. For an examination of the neural bases of the concepts and the respective
words, see: H. Damasio, TJ Grabowski, D. Tranel, RD Hichwa and A.
Damasio, "A neural basis for lexical retrieval," Nature 380 (1996): 499-505; d
Tranel, H. Damasio, and A. Damasio, "A neural basis for the retrieval of conceptual
knowledge," Neuropsychologia 35 (1997): 1319-1327; D.Tranel, C.G. Logan, R.J.
Frank and A. Damasio, "Explaining categoryrelated effects in the retrieval of
conceptual and lexical knowledge for concrete entities: Operationalization and
analysis of factors," Neuropsychologia 35 (1997): 1329-1339.
12. Daniel Dennett, Consciousness explained (cited above).

13. Alfred North Whitehead, Process and Reality. Part 3 (New York: The Free
Press, 1978, c. 1929).
14. The framework I present for the autobiographical self lends itself to thinking
about so-called multiple personalities in neurobiological terms. In these rare and
controversial cases, patients seem to switch from one particular identity with one
set of personal characteristics to another, and in some cases there are more than
two identities. The change is not as abrupt as it is reflected in The Three Faces of
Eve (in the book and in the film) and it seems that the culture around this disease
and the therapeutic environment in which patients move have a lot to do with it. the
form of clinical presentation. However, something unusual happens to these patients
that goes beyond the limits of the acceptable transformation of character that occurs
in most of us. (See Ian Hacking, Rewriting the Soul: Multiple Personalities and
the Sciences of Memory [Princeton, NJ: Princeton University Press, 1995].) It is
possible that instead of having a single set of gathering points for identity generation
and personality, that is, a single set of convergence zones and availabilities for a
single identity and a single personality connected with a single organism, these
individuals may create, due to various circumstances of their previous history, more
than one locus of control teacher.
I suspect that multiple master control loci are located in the temporal and frontal
cortices and that switching from one master control to another allows identity and
personality change to occur. The change would involve thalamic coordination, as in
the case of a simple normal personality. In such patients, to some extent, it is
reasonable to speak of more than a single "autobiographical memory" and more
than one construction of identity and more than one mode of response, connected
to different life histories and anticipated futures. However, it is clear that despite
being able to exhibit more than one autobiographical self, such patients still have a
single central consciousness mechanism and a single central self. Each of the
autobiographical beings must use the same central resource. Reflecting on this fact
is intriguing.
It brings us back to the notion that the generation of the central being is closely
related to the protoser, which, in turn, is closely based on the representations of a
single body in its single brain. Given a set of representations for a state of the body,
it would require a greater pathological distortion to generate more than one protoser
and more than one central being. It is probable that such a distortion was
incompatible with life. On the other hand, the generation of the autobiographical
being occurs at a higher anatomical and functional level, undoubtedly connected to
the central being but partially independent of it and, therefore, less influenced by
the strong biological shadow of a singular organism.
The distinction between the strongly constrained organization of the central
self, tied to biological organization inevitably, and the organization of autobiographical
memory, potentially unfettered by biological constraints in certain degrees of
freedom, underscores the different degrees of reference to nature or to the culture
of the central self and the autobiographical self, respectively.
Interestingly, following this idea there is evidence that although multiple personalities
can be linked to certain types of biological propensity, for their development and
conformation they depend very much on cultural factors.
15. "Gott, welch Dunkel here!" Ludwig van Beethoven, Fidelio, Act 2, Scene 1.
16. D. Schacter, 1996, ibid.; A. Damasio, D. Tranel, and H. Damasio, "Face agnosia
and the neural substrates of memory," Annual Review of Neuroscience 13 (1990):
89-109.
17. ER Dobbs, The Greeks and the Irrational (Berkele y : University of California
Press, 1951).
18. J. Jaynes, The Origin of Consciousness (cited above).

19. Kathleen Wilkes has written an interesting essay on the word consciousness that
complements the differences I make here by examining how some languages, such
as Chinese and Hungarian, deal with the concept. See KV Wilkes, "–, yishi, duh, um,
and consciousness," in Consciousness in Contemporary Science, A.
J. Marcel and E. Bisiach, eds. (Oxford: Clarendon Press, 1992): 16-41.
20. Jean-Pierre Changeux, Fondements naturels de l'éthique (Paris: Editions

Odile Jacob, 1993); J.-P. Changeux, Une même éthique pour tous? (Paris:
Editions Odile Jacob, 1997); J.-P. Changeux and Paul Ricoeur, Ce qui nous fait
penser: La nature et la rêgle (Paris: Editions Odile Jacob, 1998). Spanish edition:
What makes us think: nature and the rule, Peninsula Editions, SA, 1999; D.
Dennett, Consciousness explained (cited above); B. Baars, A Cognitive Theory
of Consciousness (cited above); J. Newman, "Putting the puzzle together," 1997;
Robert Ornstein, The Evolution of Consciousness (New York: Prentice Hall,
1991). Spanish edition: The evolution of consciousness, Ediciones Salamandra,
1994; Robert Ornstein and Paul Ehrlich, New World, New Mind (New York: Simon
and Schuster, Touchstone, 1989).
1. F. Plum and J. Posner, The Diagnosis of Stupor and Coma (cited above) is a
recommended reference for further discussion.
2. The idea that neurologists have formed from cases of coma and vegetative state
(that consciousness is interrupted at its very core and the mind is suspended for all
intents and purposes) is equally clear to lay observers on the subject and appears
in popular culture. The film Reversal of Fortune [The von Bulow Mystery] provides
a good example. Scripted by Nicholas Kazan, the film traces the events that lead
to Sunny von Bulow's coma and persistent vegetative state. Shortly after the start
there is a shot of Sunny's absolutely still body (played by Glenn Close) accompanied
by her own voice telling us that she is no longer conscious or capable of acting!
"Brain dead, the body better than ever," he says. The audience immediately grasps
the absurdity of his black humor. That a comatose character narrates his state for
the public is only one step away from the even more absurd notion that a dead
person recounts the events that have led to his death. By the way, that is precisely
what Billy Wilder forced his character Joe Gillis to do in his remarkable Sunset
Boulevard [Twilight of the Gods]. At the beginning of the film, the dead Joe Gillis
(played by William Holden) gently floats face down in Gloria Swanson's pool and
begins to tell the audience, voiceover, how he was shot and killed. That these
dramatic devices work so well and are so memorable indicates the extent to which
core notions of what consciousness is and is not have been accepted by non-
specialists.
3. Ann B. Butler and William Hodos, "The reticular formation," in Comparative

Vertebrate Neuroanatomy: Evolution and Adaptation (New York: Wiley-Liss,
Inc., 1996): 164-179.
4. Coma and persistent vegetative state can also be caused by extensive bilateral
damage to the thalamus or extensive bilateral damage to the cerebral cortex.
Coma and persistent vegetative state are most often caused by structural
damage to the brain, something other than metabolic changes. Common causes of
such damage are cerebrovascular accident, which ends in a stroke, and head
injuries, which produce results similar to those of a stroke in that either direct
mechanical injury or injury to blood vessels blood vessels, the brain tissue eventually
collapses. However, there may be other causes of these illnesses and there are
interesting correlations between coma and persistent vegetative state as outlined
below.
When coma occurs as a result of structural damage, stroke, or head injury, the
location of the injury is as indicated in the previous section: there is damage to the
upper half of the brainstem tegmentum at the level of the upper bridge or at the level
of the midbrain, and the hypothalamus is also usually damaged. But coma can also
be caused by specific damage to specific nuclei of the thalamus, namely, the
intralaminar nuclei. These are part of the ascent pathway that originates in the brain
stem and ends up spreading throughout the cerebral cortex. Note that in all these
cases of structural damage it is necessary that both sides, right and left, of the
structure be damaged. Unilateral damage to critical areas does not impair
consciousness.
5. For an example of the type of interaction that can occur between such nuclei,
see G. Aston-Jones, M. Ennis, VA Pieribone, WT Nickell, and MT
Shipley, "The brain nucleus locus coeruleus: Restricted afferent control of a broad
efferent network," Science 234 (1986): 734-737; and BE Van Bockstaele and G.
Aston-Jones, "Integration in the ventral medulla and coordination of sympathetic,
pain and arousal functions," Clinical and Experimental Hypertension 17 (1995):
153-165.
6. Carlo Loeb and John Stirling Meyer, Strokes due to Vertebro-Basilar Disease;
Infarction, Vascular Insufficiency and Hemorrhage of the Brain Stem and
Cerebellum (Springfield, Ill.: Charles C. Thomas, 1965): 188; R. Finchman, T.
Yamada, D. Schottelius, S. Hayreh, and A. Damasio, "Electroencephalographic
absence status with minimal behavior change," Archives of Neurology 36 (1979):
176-178.
7. Locked-in syndrome is usually caused by structural damage to the anterior

pontine and midbrain, as noted above, but can also be caused by severe
polyneuropathy, a situation in which the nerves that carry the necessary signals for
the contraction of the muscles are so impaired that there is generalized paralysis.
Some drugs can also mimic the lockdown condition. The drug known as curare,
which blocks the nicotinic acetylcholine receptors necessary for nerve fibers to
order muscle contraction, causes generalized paralysis of muscles that move
voluntarily. Smooth (non-striated) muscle contraction depends on a different type of
receptor, muscarinic receptors, and therefore curare does not block neuromuscular
transmission to these receptors. As a result, involuntary commands to alter the
caliber of blood vessels or to modify the state of various internal organs, which
occur in emotion and simple homeostatic regulation, can continue to occur in a
completely curarized individual.
8. F. Plum and J. Posner, The Diagnosis of Stupor and Coma (cited above).
9. AB Scheibel and ME Scheibel, "Structural substrates for integrative patterns in

the brainstem reticular core," Reticular Formation of the Brain, H. Jasper, LD
Proctor, R.S. Knighton, DC Noshy, and RT Costello, eds. (Boston: Little, Brown,
1958): 31-55.
10. Alf Brodal, The Reticular Formation of the Brain Stem: Anatomical Aspects
and Functional Correlations (Edinburgh: The William Ramsay Henderson Trust,
1959); J. Olszewski, "Cytoarchitecture of the human reticular formation," in Brain
Mechanisms and Consciousness, JF Delafresnaye et al., eds. (Springfield, Ill.:
Charles C. Thomas, 1954): 54-80; W. Blessing, "Inadequate frameworks for
understanding bodily homeostasis," Trends in Neurosciences 20 (1997): 235-239.
11. J. Allan Hobson, The Chemistry of Conscious States: How the Brain
Changes Its Mind (New York: Basic Books, 1994).
12. G. Moruzzi and HW Magoun, "Brain stem reticular formation and activation of
the EEG," Electroencephalography and Clinical Neurophysiology 1 (1949):
455-473; F. Bremer, "Cerveau "isolé" et physiologie du sommeil", CR Soc. Biol.
118 (1935): 1235-1241.
13. R. Llinás and D. Paré, "Of dreaming and wakefulness," Neuroscience 44

(1991): 521-535; M. Steriade, «New views on the morphology, chemical transmitters
and physiological actions of the ascending brain stem reticular system», Archives
Italiennes de Biologie 126 (1988): 225-238; M. Steriade, "Basic mechanisms of
sleep generation," Neurology 42 (1992): 9-17; M. Steriade, «Central core
modulation of spontaneous oscillations and sensory transmission in thalamocortical
systems», Current Opinion in Neurobiology 3 (1993): 619-625; m.
Steriade, "Brain activation, then (1949) and now: Coherent fast rhythms in
corticothalamic networks," Archives Italiennes de Biologie 134 (1995): 5-20; MH
J. Munk, PR Roelfsema, P. Koenig, AK Engel, and W. Singer "Role of reticular
activation in the modulation of intracortical synchronization," Science 272 (1996):
271-274; JA Hobson, The Chemistry of Conscious States (cited above); R. Llinás
and U. Ribary, «Coherent 40-Hz oscillation characterizes dream state in humans»,
Proceedings of the National Academy of Sciences of the United States 90
(1993): 2078-2081.
14. For a review of the anatomy of the acetylcholine nuclei, see M.

Mesulam, C. Geula, M. Bothwell, and L. Hersch, "Human reticular formation: Cholinergic
neurons of the pedunculopontine and laterodorsal tegmental nuclei and some cytochemical
comparisons to forebrain cholinergic neurons," The Journal of Comparative Neurology
283 (1989): 611- 633. For general reviews of monoamine systems, see FE Bloom, "What
is the role of general activating systems in cortical function?" in Neurobiology of the
cortex, P. Rakic and W. Singer, eds. (New York: John Wiley & Sons Limited, 1997):
407-421; RY
Moore, "The reticular formation: monoamine neuron systems," in The Reticular Formation
Revisited: Specifying Function for a Nonspecific System, JA Hobson and MAB
Brazier, eds. (New York: Raven Press, 1980): 67-81.
15. This is not the place to review these interesting discoveries, although some
references are provided in case the reader wishes to expand on this matter.
See AJ Hobson, The Chemistry of Conscious States; M. Steriade, «Basic
mechanisms of sleep generation», 1992.
16. MHJ Munk, et al., "Tole of reticular activation," 1996; M. Steriade, "Arousal:
revisiting the reticular activating system," Science 272 (1996): 225-226.
17. M. Steriade and M. Deschenes, "The thalamus as a neuronal oscillator," Brain

Research 320 (1984): 1-63. See also JE Bogen, for a very relevant review in "On
the neurophysiology of consciousness: 1. An overview," Consciousness and
Cognition 4 (1995): 52-62.
18. DA McCormick and M. von Krosigk, “Corticothalamic activation modulates

thalamic firing through glutamate “metabotropic” receptors,” Proceedings of the
National Academy of Sciences of the United States 89 (1992): 2774-2778; R.
Llinás and D. Paré, "Of dreaming and wakefulness" (cited above), 1991.
19. A. Brodal, The Reticular Formation of the Brain Stem (cited above).
20. F. Bremer, "Cerveau “isolé” et physiologie du someil” (cited above).

21. C. Batini, G. Moruzzi, M. Palestini, G. Rossi, and A. Zanchetti, "Persistent

pattern of wakefulness in the pretrigeminal midpontine preparation," Science 128
(1958): 30-32.
22. Another significant experiment related to the first prediction concerns the study
in cats carried out by Sprague and colleagues (JM Sprague, M. Levitt, K. Robson,
CN Liu, E. Stellar and WW Chambers) almost four decades ago : «A neuroanatomical
and behavioral analysis of the syndromes resulting from midbrain lemniscal and
reticular lesions in the cat», Archives Italiennes de Biologie 101 [1963]: 225-295).
The researchers damaged the ascending sensory tracts on one side or the other of
the upper brainstem, and in some cases on both sides. The unilateral cases are
interesting on their own, but I will limit myself to commenting on the bilateral cases.
As a result of the lesions, all sensory input describing the body's state was cut off
and thus out of reach of the upper midbrain, hypothalamus, thalamus, and cerebral
cortex. The lesions also disrupted auditory and vestibular input. The lower and
middle brainstem reticular nuclei, however, continued to receive somatosensory
signals, although it is likely that at least some of the signals to the reticular nuclei
from the cerebral cortex were also blocked by the lesions. The result of these
lesions was a profound change in behavior characterized by an abolition of
emotionality, neglect of olfactory stimuli (which enter the brain at a high level,
directly to the cerebral cortex), and stereotyped and aimless behaviors. unrelated
to surrounding stimuli and to the needs of the animals. Sprague and his collaborators
described the animals in a very suggestive way, saying that they looked like
automatons. They were awake but emotionless and unconnected to the situation.
And so they remained for two and a half years until they were sacrificed for the
purpose of a post-mortem study.
The suggestions and questions raised by the study are fascinating. At a

minimum, the study seems to indicate that the reticular nuclei can generate
wakefulness and can enable behavior but do not guarantee the kind of appropriate
and adaptive behavior that indicates the presence of awareness and deliberation.
The study also suggests that a continued diet of cues about the body's current state
may be necessary to maintain emotion and, in all likelihood, consciousness. This
suggestion must be qualified in part by the possibility that damage to the pathways
that start from the cortex and reach the reticular nuclei contributed to the defect,
although it is not reasonable to assume that only damage to information coming
down from the cortex can explain the results. Finally, I must point out the similarity
between some of the behaviors seen in cats and the presentation of patients with
the partial disorders of consciousness that I have described above, for example,
with epileptic automatism. Wakefulness is present but the behaviors are stereotyped,
not part of a sensible plan related to the context, and there is no evidence of central
consciousness or central being being formed.
For anyone interested in the history of neuroscience, I should add that this
experiment led Sprague to investigate the role of the superior colliculi in vision.
Sprague saw that the injuries he had produced had unintentionally severed beneath
the superior colliculi. All cats exhibited the abnormalities noted above as well as a
lack of vision. In the one cat in which the colliculus was not seen to be sectioned,
the abnormalities were still present but the lack of vision was absent (JM Sprague
in The History of Neuroscience in Autobiography, LR Squire, ed.
[Washington, DC: Society for Neuroscience, 1996]).

23. MHJ Munk, PR Roelfsema, P. Koenig, AK Engel, and W. Singer, "Role of

reticular activation in the modulation of intracortical synchronization," Science 272
(1996): 271-274.
24. S. Kinomura, J. Larsson, B. Gulyás, and PE Roland, "Activation by attention of

the human reticular formation and thalamic intralaminar nuclei," Science 271
(1996): 512-515.
25. R. Bandler and MT Shipley, "Columnar organization in the midbrain

periaqueductal gray," Trends in Neurosciences 17 (1994): 379-389; MM
Behbehani, "Functional characteristics of the midbrain periaqueductal gray,"
Progress in Neurology 46 (1995): 575-605; JF Bernard and R. Bandler, "Parallel
circuits for emotional coping behavior," J. Comp. Neurol. 401 (1998): 429-436.
26. J. Parvizi, GW Van Hoesen, and A. Damasio, "Severe pathological changes of

the paracbrachial nucleus in Alzheimer's disease," NeuroReport 9 (1998):
4151-4154.
27. GW Van Hoesen and A. Damasio, "Neural correlates of cognitive impairment in

Alzheimer's disease," in Handbook of Physiology, vol. 5, "Higher Functions of the
Nervous Systems," V. Mountcastle and F. Plum, eds. (Bethesda, Md.: American
Physiological Society, 1987): 871-898; T. Grabowski and A. Damasio, "Definition,
clinical features and neuroanatomical basis for dementia," in The Neuropathology
of Dementia, MM Esiri and JH Morris, eds. (New York: Cambridge University Press,
1997): 1-20.
28. As we map the changes in Alzheimer's at different times of the disease, it will
become possible to correlate neural locations and cognitive and behavioral defects
with more precision, something that should be done vigorously given that it is one
of the few means of we have to respond to these problems. In all likelihood, the
newly discovered Alzheimer's pathology in the parabrachial nucleus will end up
being the cause of some, if not all, of the dysfunction. It will almost certainly be
related to the autonomic disorder that occurs in these patients and may even be a
possible cause of the disproportionate incidence of respiratory and gastrointestinal
diseases.
29. There is an intriguing suggestion that when glycogen stores stored in glial cells
are depleted by repeated neurotransmitter burst, adenosine is released from glial
cells, inducing non-REM sleep. In turn, non-REM sleep allows glycogen to
accumulate again in the glia. See JH Benington and HC Heller, "Restoration of
brain energy metabolism as the function of sleep," Progress in Neurobology 45
(1995): 347-360.
30. For a review, see B. Vogt, E. Nimchinsky, and P. Hof, "Primate cingulate cortex
chemoarchitecture and its disruption in Alzheimer's disease," in Handbook of
Chemical Neuroanatomy, vol 13, The Primate Nervous System, Part I, FE
Bloom, A. Bjorklund, and T. Hokfelt, eds. (New York: Elsevier Science BV, 1997).
31. O. Devinsky, MJ Morrell, and BA Vogt, "Contributions of anterior cingulate

cortex to behavior," Brain 118 (1995): 279-306; P. Maquet, J.-M. Peters, J. Aerts,
G. Delfiore, C. Degueldre, A. Luxen, and G. Franck, "Functional neuroanatomy of
human rapid-eye-movement sleep and dreaming," Nature 383 (1996 ): 163-166; P.
Maquet, C. Degueldre, G. Delfiore, J. Aerts, J.-M. Peters, A. Luxen, and G. Franck,
“Functional neuroanatomy of human slow wave sleep,” The Journal of
Neuroscience 17 (1997): 28072812; T. Paus, RJ Zatorre, H. Hofle, Z.
Caramanos, J. Gotman, M. Petrides, and AC Evans, "Time-related changes in
neural systems underlying attention and arousal during the performance of an
auditory surveillance task," Journal of Cognitive Neuroscience 9 (1997): 392-408; P.
Rainville, B. Carrier, R. Hofbauer, M. Bushnell, and G. Duncan, "Dissociation of
pain sensory and affective dimensions using hypnotic modulation," Pain (in press); P.
Fiset, T. Paus, T. Daloze, G. Plourde, N. Hoffle, N. Hajj-Ali, and A. Evans, “Effect of
propofol-induced amnesia on regional cerebral blood-flow: A positron emission
tomography (PET) study », Society for Neuroscience 22 (1996): 909: AR Braun,
TJ Balkin, NJ Wesensten, F. Gawdry, RE Carson, M. Varga, P. Baldwin, G.
Belenky and P. Herscovitch, "Dissociated pattern of activity in visual cortices and
their projections during human rapid eye movement sleep," Science 279 (1998):
91-95.
32. See A. Damasio and GW Van Hoesen, "Emotional disturbances," in

Neuropsychology of Human Emotion, 1983; MI Posner and SE Petersen, "The
attention system of the human brain," Annual Review of Neuroscience 13 (1990):
25-42.
33. Macdonald Critchley, The Parietal Lobes (London: E. Arnold, 1953).

34. Barry E. Stein and M. Alex Meredith, The Merging of the Senses (Cambridge,
Mass.: MIT Press, 1993).
35. The abundant interconnectivity of the superior colliculi led Bernard Strehler to
suggest that they are, almost literally, the seat of consciousness. This is a very
exaggerated point of view and I absolutely do not support it here. The hypothesis
that I present is, of course, completely different, but Strehler's review of colicular
function has been very revealing. B. Strehler, «Where is the self? A neuroanatomical
theory of consciousness”, Synapse 7 (1994): 44-91.
36. EG Jones, "Viewpoint: The core and matrix of thalamic organization,"

Neuroscience 85 (1998): 331-345. We also know, from the works of EG
Jones with primates, that diffusely projecting neurons from different thalamic nuclei
(including, but not exclusively, intralaminar nuclei) and whose input comes from the
brainstem tegmentum, have a specific chemical signature: calbindin. On the other
hand, the neurons of a specific transmitter nucleus whose information inputs come
from the lemniscus tract and whose projection is topographically ordered, present
a different marker: parvalbumin.
3 7. HT Chugani, « Metab olic im a gin g: A win dowonbr ain dev elopmentand pla
s ticit y », Neuro scien tis t 5 (1999): 29-40.
38. A. Damasio, "Disorders of complex visual processing," in Principles of

Behavioral Neurology, M.-Marcel Mesulam, ed., Contemporary Neurology Series
(Philadelphia: FA Davis, 1985): 259-288.
39. Lawrence Weiskrantz, Consciousness Lost and Found: A Neuropsychological

Exploration (New York: Oxford University Press, 1997).
40. A. Damasio, The error of Descartes; RM Brickner, "An interpretation of frontal

lobe function based upon the study of a case of partial bilateral frontal lobectomy,"
Research Publications of the Association for Research in Nervous and Mental
Disease 13 (1934): 259-351; Richard M. Brickner, The Intellectual Functions of
the Frontal Lobes: A Study Based upon Observation of a Man after Partial
Bilateral Frontal Lobectomy (New York: Macmillan, 1936); Joaquín Fuster, The
Prefrontal Cortex: Anatomy, Physiology and Neuropsychology of the Frontal Lobe, 2nd ed.
(New York: Raven Press, 1989). Note that I do not include the premotor cortices of
areas 6 and 24 among the prefrontal cortices, since they are functionally and
architecturally distinct. Bilateral damage to the premotor cortices is a rare natural
event that has been difficult to investigate experimentally.
1. These mechanisms are proposed in El e rro r de D escar t e s, where it is examined in an

end detail alle.
2. See Vittorio Gallese and Alvin Goodman, "Mirror neurons and the simulation
theory of mind-reading," Trends in Cognitive Sciences 2: 12 (1998): 493-501.
3. For a discussion of this important aspect of background sensations the reader is

referred to the work on peptides in relation to emotions by Jaak Panksepp. See J.
Panksepp, E. Nelson, and M. Bekkedal, "Brain systems for the mediation of social
separation-distress and social-reward: Evolutionary antecedents and neuropeptide
intermediaries," Annals of the New York Academy of Sciences 807 (1997): 78
-100; EE Nelson and J. Panksepp, "Brain substrates of infant-mother attachment:
Contributions of opioids, axytocin and norepinephrine," Neuroscience and
Biobehavioral reviews 22 (1998): 437-452.
4. I am grateful to the readers of Descartes' Error who brought to my attention the

work of Susanne Langer (Philosophy in a New Key: A Study in the Symbolism
of Reason, Rite and Art [Cambridge, Mass.: Harvard University Press, 1942 ], and
Daniel Stern (The Interpersonal World of the Infant: A View from Psychoanalysis
and Developmental Psychology [New York: Basic Books, 1985]).
5. GW Hohmann, "Some effects of spinal cord lesions on experienced emotional

feelings," Psychophysiology 3 (1966): 143-156; P. Montoya and R. Schandry,
"Emotional experience and heartbeat perception in patients with spinal-cord injury
and control subjects," Journal of Psychophysiology 8 (1994): 289-296.
6. WB Cannon, "The James-Lange Theory of Emotions: A Critical Examination and

an Alternative Theory," American Journal of Psychology 39 (1927): 106-124.
7. J.-D. Bauby, The Diving Bell and the Butterfly (cited above); J. Mozersky,
Locked In (cited above).
8. JL McGaugh, "Involvement of hormonal and neuromodulatory systems in the

regulation of memory storage," Annual Review of Neuroscience 12 (1989):
255-287; JL McGaugh, "Significance and remembrance: the role of neuromodulatory
systems," Psychological Science 1 (1990): 15-25.
1. JF Kihlstrom, "The cognitive unconscious," 1987; AS Reber, Implicit Learning

and Tacit Knowledge (cited above).
2. See Victoria Fromkin and Charles Rodman, An Introduction to Language, 6th ed.
(New York: Harcourt Brace, 1997).
3. For the evolutionary antecedents of unconscious knowledge of grammar, see

Steven Pinker's The Language Instinct (New York: Morrow, 1994). Spanish
edition: The language instinct: how the mind creates language, Alianza Editorial,
2012. For the nonconscious nature of artificial grammars, see Reber, Implicit
Learning (cited above).
4. A. Bechara, D. Tranel, H. Damasio, R. Adolphs, C. Rockland, and A. Damasio,

"A double dissociation of conditioning and declarative knowledge relative to the
amygdala and the hippocampus in humans," Science 269 (1995 ): 1115-1118; s.
Corkin, "Tactually guided maze learning in man: Effects of unilateral cortical
excisions and bilateral hippocampal lesions," Neuropsychologia 3 (1965): 339-351;
D. Tranel and A. Damasio, "Knowledge without awareness: An autonomic index of
facial recognition by prosopagnosics," Science 228 (1985): 1453-1454; A.
Damasio, D. Tranel, and H. Damasio, "Face agnosia and the neural substrates of
memory," Annual Review of Neuroscience 13 (1990): 89-109; L. Weiskrantz,
Consciousness Lost and Found (cited above).
5. A. Bechara, H. Damasio, D. Tranel, and A. Damasio, "Deciding advantageously

before knowing the advantageous strategy," Science 275 (1997): 1293-1295; R.
Adolphs, H. Damasio, D. Tranel, and A. Damasio, "Cortical systems for the
recognition of emotion in facial expressions," Journal of Neuroscience 16 (1996):
7678-7687; A. Bechara, A. Damasio, H. Damasio, and SW Anderson, "Insensitivity
to future consequences following damage to human prefrontal cortex," Cognition
50 (1994): 7-15.
6. F. Jackson, "Epip henomen al qu alia," Philosophical Quarterly 32 ( 1982 ):

127-136.
7. Patricia Churchland has written a delightful examination of Mary's thought

experiment in "The Hornswoggle Problem," Journal of Consciousness Studies 3
(1996): 402-408.
1. Nicolas Malebranche, De la recherche de la verité (Paris: A. Pralard,

1678-1679): 914. "C'est par la lumière et par une idée claire que l'esprit voit les
essences des choses, les nombre et l'étendue. C'est par une idée confuse ou par
sentiment, qu'il juge de l'existence des créatures, et qu'il connaît la sienne
propre» (author's translation). I thank Fernando Gil for drawing my attention to
Malebranche.
1. A. Einstein, cited in J. Hadamard, The Psychology of Invention in the

Mathematical Field (Princeton, NJ: Princeton University Press, 1945).
2. D. Hubel, Eye, Brain and Vision (New York: Scientific American Library, 1988).
For the foundations of selective systems in biology, see Jean-Pierre Changeux,
Neuronal Man: The Biology of Mind (New York: Pantheon, 1985), and Gerald
Edelman, Neural Darwinism: The Theory of Neuronal Group Selection (New
York: Basic Books, 1987).
3. A. Damasio, "Time-locked multiregional retroactivation: A systems level proposal

for the neural substrates of recall and recognition," Cognition 33 (1989): 25-62; A.
Damasio, "The brain binds entities and events by multiregional activation from
convergence zones," Neural Computation 1 (1989): 123-132; A.
Damasio, 1994/1995 (cited above); G. Edelman, Neural Darwinism (cited above);
R. Llinás and D. Paré, "Of dreaming and wakefulness," Neuroscience 44 (1991):
521-353.
4. W. Singer, C. Gray, A. Engel, P. Koenig, A. Artola, and S. Brocher, "Formation of

cortical cell assemblies," Symposia on Quantitative Biology 55: 929-952.
5. F. Crick, The Scientific Search for the Soul (cited above); F. Crick and C.
Koch, "Constraints on cortical and thalamic projections: The no-strong-loops
hypothesis," Nature 391 (1998): 245-250.
6. J.-P. Changeux, Neuronal Man (cited above); G. E d elm an, Neura l Darwinism
(cited above).
* The author makes an untranslatable play on words here. Absent without leave
means "absent without permission" although it can also be understood as "absent
without leaving". I retain the first option because the meaning of the second is
clearly revealed later in the text. (N. of the t.)
* The author distinguishes here between consciousness and conscience , which

I have translated throughout the book as conscience and consciousness, respectively.
Then, and in successive chapters, the author himself is in charge of establishing the
nuances of the case, valid in both languages, for which it is enough to keep this
small, but important, distinction in mind. (N. of the t.)
* It refers, of course, to the famous scene of the murder in the shower of the film
Psycho by Alfred Hitchcock. (N. of the t.)
* The author refers to Pollyanna, the girl protagonist of the novel of the same
name, the work of the North American author Eleanor Porter. The girl has an
incurable optimism and always tends to see the bright side of all things, which
leads her to judge the world in which she lives very biasedly. (N. of the t.)
* ra pid - e ye - mo ve men t, in English ( N. del t.)

* More surprisingly, in Castilian Spanish, a language logically full of Gallicisms, we

use "internal environment" without any cover. I have preferred to keep the entire
original paragraph of the author, including the English expression internal milieu,
which with its mixture of English and French words clarifies the comment. (N. of the t.)
* The author refers to the lyrics of Cole Porter's song I've got you under my skin,
which is a declaration of love: "I carry you under my skin / I carry you deep inside
my heart." Perhaps the best known version is the one popularized by Frank Sinatra.
(N. of the t.)
* I have literally translated the paragraph, keeping the author's examples, although
it is obvious that Romance languages and Saxon and Germanic languages offer
some substantial differences, which tend to invalidate the etymological background
of the exposition. See, if not, the difference between our "being unconscious" or
"being unconscious" where the significant load does not fall on the noun but on the
verb used, unlike in English or German. It is not a simple question of context of
linguistic pragmatics. (N. of the t.)
* Actor Christopher Reeve (1952-2004), protagonist of the films of

Superman suffered a fall from a horse in 1995 and needed to use a wheelchair.
wheels and an artificial respirator until his death. (N. of the t.)
* One of the most important theater and concert wings in the United States.
(N. of the t.)
* Brigadoon is a musical comedy released in 1947 and composed by Alan Jay

Lerner and Frederick Loewe, inspired by the narration of the German Friedrich
Gerstäcker Germelshausen (1860). Its protagonists get lost and mysteriously
appear in Brigadoon, a small Scottish town that wakes up once every hundred
years. In 1954, the film version directed by Vincente Minnelli was released, with
Gene Kelly, Cyd Charisse and Van Johnson. (N. of the t.)
The feeling of what is happening

Anthony Damasius
The total or partial reproduction of this book, nor its incorporation into a computer system, nor
its transmission in any form or by any means, be it electronic, mechanical, photocopying,
recording or other methods, without prior permission is not permitted. and in writing from the
publisher. The infringement of the aforementioned rights may constitute a crime against
intellectual property (Art. 270 and following of the Penal Code)
Contact CEDRO (Spanish Center for Reprographic Rights) if you need to reproduce any
fragment of this work.
You can contact CEDRO through the website www.conlicencia.com or by phone at 91 702 19
70 / 93 272 04 47
Original title: The Feeling of What Happens
Cover design, Booket / Grupo Planeta Editorial Area © Cover photography,

Shutterstock
© Antonio Damasio, 1999
© for the translation, Francisco Páez de la Cadena Tortosa, 2001
© Editorial Planeta, SA, 2018 Ediciones

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Avda. Diagonal, 662-664, 08034
Barcelona (Spain) www.edestino.es
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Illustrations courtesy of Dr. Hanna Damasio
First edition in electronic book (epub): March 2018
ISBN: 978-84-233-5358-3 (epub)
Conversion to electronic book: Newcomlab, SLL

www.newcomlab.com
say yes to life

Garriga, Joan
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Buy it and start reading
More than 100,000 readers We know that we cannot always be

happy, and although we are aware of this reality, we feel unable to
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understanding and managing it is the most powerful learning.

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her eleven cats, are the only inhabitants of an abandoned village.
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a beast in paradise
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When Blanche's parents die in a terrible accident, she and her

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A beast in paradise is the story of a saga of women who give their
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his only means of survival, but it is also a curse.
This is a novel full of passion, for a man, a land, a way of life. A
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The president of the Club de la Bahía de Santander, one of the most
powerful women in the city, has been found dead in the cabin of a
beautiful schooner that, with a few select guests from the world of
tennis, sailed the sea at dusk. The crime reminds
the novels of the "locked room" from the beginning of the last century:
the compartment was locked from the inside, both the strange wound
on the body of the businesswoman and the mysterious method used
to perpetrate the murder are inexplicable and all the guests at the
party They seem to have reasons to have ended his life. No one
could have left or entered the ship to commit the crime or escape.
Who has killed Judith Pombo?
How? And because? The most ambitious novel by María Oruña, an
addictive and elegant thriller in which we will discover a new facet of
the life of Valentina Redondo, who, in addition to facing the most
enigmatic case of her career, must fight against a surprising and
unexpected blow to her personal life .

The Feeling of What Happens-Antonio Damasio

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The Feeling of What Happens-Antonio Damasio

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Machine Translated by Google

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FOURTH PART. FORCED TO KNOW CHAPTER NINE

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The feeling of what is happening

Translation by Francisco Páez of Cadena Tortosa

Or the waterfall, or music heard so deep inside

The question of who I was consumed me.

Do you want to be covered or do you want to be seen?

And your clothing... how it becomes you!... starred with

My first thanks go to Seamus Heaney for his unwitting contribution

During the preparation of the manuscript I was fortunate to spend

Lundy, which was much less severe than I expected.

I am equally grateful to the friendship with which, once the

I am grateful to my colleagues in the Department of Neurology

My assistant Neal Purdum coordinated the preparation of the

I am grateful to Rachel Myers for her clever proofreading and to

I've always been fascinated by that particular moment when,

However, as I prepare for the launch of this book and as I reflect on

It is not easy to investigate any aspect of the human mind, and

Although for me consciousness is not the pinnacle of biological

consciousness none of these states would be known to us. Let's not

elemental, consciousness allows us to recognize the irresistible urge to stay

I called him again and he said "What?"

dissolve into an unwanted unknowing to later return to consciousness:

I maintained my interest in the subject of consciousness over

I would have preferred not to witness if I had been able to choose.

He could also imagine the induction of emotions, and the subsequent

each of us who is given a sensation within the limits of his own

I realized that overcoming the self hurdle (which in my view

THE PROBLEM OF CONSCIOUSNESS

Therefore, from the perspective of neurobiology, what is the

From the perspective of neurobiology, solving this first problem consists of

The solution of this second problem requires the understanding

world. The solution also requires an understanding of how images of

Thus, at a minimum, the neurobiology of consciousness faces

This book is nothing more than an attempt to deal with the

Before proceeding further it is necessary to say a few words

could simultaneously read questions about theoretical assumptions,

Mind, behavior and brain

Consciousness is a completely private, first-person singular

of biology and have created a strange but productive alliance. For

Let me offer some examples. Areas of restricted brain damage

The importance of this advance is that a lesion analyzed in such a

mental functions or behaviors. We can postulate, for example, that a

Another example of a new type of brain index is the area of

Another index is the change in electrical conductivity measured

Reflection on neurological and neuropsychological evidence

The results of neurological observations and neuropsychological

The systems and regions in question accumulate in a limited set of

The second fact is that awareness and wakefulness can be

awake and attentive without having normal consciousness, as exemplified

In short, central consciousness is a biological phenomenon; it has a

Although I believe that expanded consciousness is also found in some non-

higher levels in humans. It depends on conventional memory and active

If it is true that the central consciousness is the rite of passage for

it is linked to the idea of an entity and corresponds to a collection of

A fifth fact: It is not uncommon for consciousness to be explained

By the same token, a theory of consciousness should not be just a

to inferences and interpretations: they are part of the biological